Primary reconstruction with PEEK implant of an intraosseous venous malformation of the lateral orbital rim

Vascular malformations are rare in the orbito-malar region being 64 cases only described since 1950. After ablation, reconstruction is crucial to avoid facial deformities. A 76-year-old male case complaining of a painful left orbital swelling is reported. TC and MRI showed the intraosseous vasal malformation imaging pattern. A segmental orbital ostectomy with immediate PEEK implant reconstruction was performed. Histopathology and immunopathology confirmed the nature of the lesion. At 1 month, the patient was satisfied about the appearance. Medical history and digital imaging patterns allow to avoid the risks of severe hemorrhage from a bony biopsy which can be life-threatening; one-block excision is the treatment of choice, reconstruction is challenging for facial aesthetics. Computer assisted reconstruction, allows to produce an alloplastic customized implant, mirroring the unaffected side into the defect, reducing operation time and overall morbidity. Histopathology and immunohistochemistry define clearly the nature of the lesion.