Osseous hemangioma in the maxillofacial region (OHMF) was first reported in the literature as a clinical entity in the middle of last century. Several fatal cases of accidental hemorrhage following tooth extraction were attributed to OHMF. The discovery of X-rays and image diagnosis should have facilitated identification of the lesion and contributed to establishing differential diagnosis with other entities. However, our review of case-reports suggests that this lesion has been misdiagnosed and mistaken for other neoplastic and non-neoplastic hemorrhagic bone lesions. The aim of this study was to analyze clinical and radiographic data obtained from our review in order to determine the diagnostic criteria for OHMF over the last twenty years. Our case study showed that OHMF occurred at a mean age of 27.3 years, and appeared at a later age in women (30.4 years). OHMF was more frequent in women with a female to male ratio of 1.6:1, although a higher ratio has been reported in the literature. The site of predilection was the premolar and molar region of the mandible (65%). Clinical diagnosis of hemangioma was performed in 7 cases only (35%); diagnosis of the remaining cases was less accurate. The most frequent radiographic feature was mixed radiodensity (70%) and radiolucency (30%). A honeycombed appearance predominated (35%). In addition, 8 cases of OHMF involved the teeth which exhibited resorption and displacement. The present study shows that image diagnosis of OHMF must be based on the critical application of increasingly complex techniques in order to define the lesion.