Intraosseous hemangiomas are rare benign vascular tumors, constituting 0.5–1% of all bone tumors, and are exceptionally uncommon in the zygomatic bone. Their diagnosis and management require a multidisciplinary approach due to potential aesthetic and functional implications.

A male in his 20s presented with an eight-year history of a painless, hard swelling over the left zygoma. Imaging revealed a radiopaque, hypervascular lesion involving the zygomatic bone and inferolateral orbit. Preoperative embolization was performed, followed by complete surgical excision and titanium mesh reconstruction. Histopathology confirmed a cavernous hemangioma.

This case highlights the importance of comprehensive imaging, angiographic assessment, and embolization to minimize intraoperative bleeding. The lesion’s radiographic and histological features supported the diagnosis. Surgical excision with clear margins is the treatment of choice, particularly for expanding lesions or aesthetic concerns.

Zygomatic intraosseous hemangiomas are extremely rare. This case highlights the importance of a multidisciplinary approach involving imaging, embolization, and surgical reconstruction.