Arteriovenous malformation in the pretragal region: case report

Surgical management of auricular arteriovenous malformations: A literature review

Auricular arteriovenous malformations (AVMs) can cause a variety of symptoms that seriously impact the patient's appearance, life, and mental well‐being. Surgery is the primary management method for auricular AVMs, but there is no consensus on how to surgically manage auricular AVMs. In this article, we document a comprehensive review of the characteristics, classification, and surgical interventions to treat auricular AVMs.

Management of arteriovenous malformation of the ear: A protocol for resection and reconstruction

OBJECTIVE

Arteriovenous malformations (AVM) of the ear show unique features. Progressive growth or inadequate management of AVMs may lead to bleeding, infection, cartilage exposure, and ultimately loss of structure. Total ear amputation is an alternative; however, due to the structural complexity of the ear, reconstruction is technically challenging. This study presents a treatment algorithm based on a clinical series, with treatment options including resection and immediate and late reconstruction.

METHODS

Between 2004 and 2018, 12 patients with auricular AVMs were treated with AVM resection and ear reconstruction at our hospital. Among these 12 patients, seven were women, and patients' ages ranged between 4 and 34 years. Parameters considered before resection and reconstruction were compromised ear extension (partial, total, or extra-auricular involvement), thickness (cutaneous and cartilaginous), symptoms (bleeding, infection, ulceration, and/or cartilage exposure), and preoperative embolization. Total resection of AVMs was planned as the first step in all cases, followed by primary closure. AVM resection was categorized into a partial or total procedure, resulting in partial or total ear defects. Reconstruction was categorized as immediate or delayed.

RESULTS

Preoperative embolization was performed in 10 patients. AVMs were totally removed, resulting in seven total ear amputations. In six of these patients, total ear reconstruction was performed 6 months later, and all patients were recurrence-free. Only one patient did not undergo ear reconstruction. Regrowth was not observed in any reconstructed ear.

CONCLUSION

Treatment of ear AVMs requires a planned approach to achieve favorable clinical outcomes and for concomitant safe and definitive reconstruction.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:1322-1326, 2020.

Radial forearm and forehead flap reconstruction following resection of a nasal arteriovenous malformation: A case report

Arteriovenous malformation (AVM) is a structural vascular abnormality in which the arterial vasculature connects with the venous vasculature without capillary connections. AVM confined to the nasal cavity is considerably rare. Blurred vision can be one of the associated symptoms. A combined approach of complete surgical resection with prior superselective embolization is the treatment of choice. Following resection, the reconstruction of facial defects, particularly in the nasal area, is challenging. The present study reports the rare case of a patient with an AVM in the nasal cavity, in which embolization, resection and flap reconstruction were performed. Embolization and complete surgical resection were used to avoid recurrence. Subsequently, a combination of free radial forearm and forehead flaps was used for the reconstruction of the nasal defect, without prosthesis. To the best of our knowledge, this is the first report of AVM confined to the nasal cavity, managed by a combination of free radial forearm and forehead flap reconstruction following complete resection. The cosmetic results of the procedure were acceptable.