Cavernous hemangiomas are rare, benign proliferations of vessels that usually occur at or just after birth. Few cases have been reported in the literature, however, involving the maxilla. We report a rare case of central cavernous hemangioma of the maxilla in an elderly male, review the literature, and discuss treatment options. An algorithm for treatment of all vascular lesions has been developed based on current literature, modern imaging and endovascular technology. With proper diagnosis, planning and treatment, large vascular lesions can be managed with minimal blood loss and morbidity. This patient was reconstructed to full function utilizing zygomaticus implants and an implant-retained prosthesis.