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Todaro M, Pashaj E, Pedicelli A, Alexandre A, Saponaro G, Gasparini G, Moro A. Arteriovenous fistula of the mandible: a case report. Oral Radiol 2024:10.1007/s11282-024-00762-6. [PMID: 38898353 DOI: 10.1007/s11282-024-00762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
Intraosseous arteriovenous malformations (AVM) are uncommon high-flow vascular malformation that can affect the maxilla or mandible. AVM may present with aspecific and misleading signs and symptoms. The diagnosis is often accidental and bleeding may represent the first symptom. Radiographically, there are few characteristic features and misdiagnosis is easy. Here we report the case of a young male affected by arteriovenous fistula on the right side of the mandible initially misdiagnosed as a cystic lesion. The patient underwent transarterial embolization of the vascular malformation and subsequently the lesion was surgically removed. 1-year follow-up showed complete healing of the mandibular bone and absence of recurrence. Intraosseous arteriovenous malformations are rare entities. However, due to their harmfulness, both clinicians and radiologists must be aware of this type of lesion and should always consider them in the differential diagnosis of osteolytic lesions.
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Affiliation(s)
- Mattia Todaro
- Maxillo-Facial Surgery Unit, IRCSS Fondazione Policlinico Universitario "A. Gemelli" - Università Cattolica del Sacro Cuore sede di Roma, 8 Largo Agostino Gemelli, 00168, Rome, Italy.
| | - Ermal Pashaj
- Centro Ospedaliero Universitario Catolico Nostra Signora del Buon Consiglio Rr. Dritan Hoxha, Tirana, Albania
| | - Alessandro Pedicelli
- Radiology and Neuroradiology, Department of Diagnostic for Images, Oncological Radioterapy and Hematology, IRCSS Fondazione Policlinico Universitario "A. Gemelli" - Università Cattolica del Sacro Cuore sede di Roma, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Andrea Alexandre
- Radiology and Neuroradiology, Department of Diagnostic for Images, Oncological Radioterapy and Hematology, IRCSS Fondazione Policlinico Universitario "A. Gemelli" - Università Cattolica del Sacro Cuore sede di Roma, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Gianmarco Saponaro
- Maxillo-Facial Surgery Unit, IRCSS Fondazione Policlinico Universitario "A. Gemelli" - Università Cattolica del Sacro Cuore sede di Roma, 8 Largo Agostino Gemelli, 00168, Rome, Italy
| | - Giulio Gasparini
- Maxillo-Facial Surgery Unit, IRCSS Fondazione Policlinico Universitario "A. Gemelli" - Università Cattolica del Sacro Cuore sede di Roma, 8 Largo Agostino Gemelli, 00168, Rome, Italy
| | - Alessandro Moro
- Maxillo-Facial Surgery Unit, IRCSS Fondazione Policlinico Universitario "A. Gemelli" - Università Cattolica del Sacro Cuore sede di Roma, 8 Largo Agostino Gemelli, 00168, Rome, Italy
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Systematic review of pediatric mandibular arteriovenous malformations. Int J Pediatr Otorhinolaryngol 2021; 150:110942. [PMID: 34673419 DOI: 10.1016/j.ijporl.2021.110942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The management of arteriovenous malformations (AVMs) can be challenging in the pediatric population. It is of utmost importance to keep in mind various management options as these lesions can have disastrous outcomes. This is a systematic review of the treatment AVMs describing the current practices so that practitioners can be aware of what is currently reported in the literature. The challenges of AVM management can be mitigated when approaching these patients through a multidisciplinary team-based approach. METHODS A systematic review of the literature was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to gain insight into pediatric mandibular AVMs. Demographics, arterial involvement, clinical symptoms, imaging, treatment, complications, follow-up, and outcomes were reviewed. RESULTS 63 articles were included in the systematic review with 106 distinct cases. The age range was from 3 to 17 years with a mean of 12 years. 51% of the patients were female. The most common clinical presentation was emergency hemorrhage (37.4%), swelling or edema (33.0%), and persistent bleeding (31.9%). The most common CT findings were osteolytic changes and radiolucencies (60.8%). With regards to treatment, 56.6% of patients had embolization alone and 34.9% were treated with embolization in combination with other surgical treatments. Of the patients who had surgical resection of the lesion, 50% had resection followed by reconstruction, 23.7% had curettage of the lesion, and 13.2% had resection/curettage then immediate reimplantation of the mandible segment. The most common complications after intervention included bleeding in 17.9% of patients and infection in 8.3% of patients. 89.5% of patients were clinically cured without recurrence at follow-up. CONCLUSION Diagnosing AVMs can be difficult as they have variable clinical and radiographical presentations. Although rare, because of risk of massive hemorrhage, it is important for healthcare professionals to be aware of this pathology. Many surgical techniques, routes of embolization, embolic material, and other experimental therapies have been described and this review shows that the most cases had embolization as a part of the treatment. The role of therapies targeted at the molecular level still needs to be further explored.
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Chawla A, Gill S, Sharma S, Kumar V, Logani A. Endodontic implications of a patient with arteriovenous malformation: a case report and literature review. Int Endod J 2021; 54:975-987. [PMID: 33410128 DOI: 10.1111/iej.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
AIM To present the endodontic management of a patient diagnosed with a high-flow arteriovenous malformation (AVM) requiring root canal treatment and to discuss the relevant endodontic literature for this rare but significant problem. SUMMARY AVM is a complex communication of an artery and a vein in which the oxygenated blood is forced away from the intended tissue. The incidence of its occurrence in the face and neck is rare, and when present, the most common sign is gingival bleeding. Arteriovenous malformation is both a diagnostic and therapeutic challenge for dentists. Also, there is ambiguity regarding the precautions to be taken whilst doing endodontic procedures in such cases. Hence, there is a need to understand the disease process and its implications in order to prevent life-threatening complications during treatment. This case report highlights the successful endodontic management of a cariously exposed right maxillary second premolar in a patient diagnosed with high-flow AVM. On an orthopantomogram, the AVM was spreading in the left submandibular space involving the left ramus area. The clinical findings of limited mouth opening with inter-appointment swelling and trismus during treatment made the case unusual and challenging. This paper addresses the current understanding of the classification, diagnosis, clinical features and endodontic management, together with specific guidelines and recommendations whilst performing endodontic procedures in AVM cases. KEY LEARNING POINTS The classification and oral manifestations of AVM must be known and understood. Practitioners should be aware of the radiographic appearance of AVM. Recommended precautions should be taken when carrying out restorative and endodontic procedures in a patient with AVM. Antibiotic prophylaxis may be considered before endodontic treatment in a patient with AVM. Multidisciplinary treatment planning may be required.
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Affiliation(s)
- A Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - S Gill
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - S Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - V Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - A Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Monteiro JLGC, de Arruda JAA, Figueiredo Leal JL, Batista LL, Célia de Aguiar Soares Carneiro S, do Egito Vasconcelos BC. Embolization as the Primary Treatment for Mandibular Arteriovenous Malformations: An Analysis of 50 Literature Reports and of an Illustrative Case. J Oral Maxillofac Surg 2018; 76:1695-1707. [PMID: 29551518 DOI: 10.1016/j.joms.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the present report is to describe 50 cases in the literature of mandibular arteriovenous malformations (AVMs) in which embolization was the primary treatment and to discuss details such as age, gender, materials used, outcome of embolization, time of follow-up, and intra- or postprocedure complications. An illustrative case in which reossification was noticed after embolization also is presented. PATIENTS AND METHODS The study was carried out in 2 steps. In the first, an electronic search without time restriction for embolization as the primary treatment for mandibular AVMs was performed on Medline through PubMed. In the second, the case of a patient with mandibular AVM and massive oral bleeding episodes is described after a long-term follow-up. RESULTS Clinical stability with the cessation of oral bleeding episodes was detected in 25 cases and 2 cases were planned for another embolization session. Clinical stability and reossification were detected in 23 of the 50 cases included. Complications were reported in 50% of cases, but most were minor and transient. CONCLUSION Currently, owing to more sophisticated imaging techniques, the diagnosis of mandibular AVMs is quicker and new, less invasive techniques that avoid surgical resection have proved effective. It should be emphasized that these techniques are not without complications and that long-term monitoring is extremely important.
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Affiliation(s)
- João Luiz Gomes Carneiro Monteiro
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, PE, Brazil.
| | - José Alcides Almeida de Arruda
- Postgraduate Student, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jefferson Luiz Figueiredo Leal
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, PE, Brazil
| | - Laécio Leitão Batista
- Head of Interventional Radiology, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Suzana Célia de Aguiar Soares Carneiro
- Adjunct Professor, School of Dentistry, Faculdade Integrada de Pernambuco and Service of Oral and Maxillofacial Surgery, Hospital da Restauração, Recife, PE, Brazil
| | - Belmiro Cavalcanti do Egito Vasconcelos
- Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco and Service of Oral and Maxillofacial Surgery, Hospital da Restauração, Recife, PE, Brazil
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Wang D, Su L, Han Y, Wang Z, Zheng L, Fan X. Absolute Ethanol Embolisation of Mandibular Arteriovenous Malformations Following Direct Percutaneous Puncture and Release of Coils via a Microcatheter. Eur J Vasc Endovasc Surg 2017; 53:862-869. [DOI: 10.1016/j.ejvs.2017.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Colletti G, Dessy M, Allevi F, Dalmonte P, Bardazzi A, Deganello A, Biglioli F. Malformazione arterovenosa inizialmente diagnosticata come cisti follicolare. DENTAL CADMOS 2016. [DOI: 10.1016/s0011-8524(16)30068-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Su L, Wang D, Han Y, Wang Z, Fan X. Salvage treatment of hemorrhagic arteriovenous malformations in jaws. J Craniomaxillofac Surg 2015; 43:1082-7. [PMID: 26154397 DOI: 10.1016/j.jcms.2015.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/17/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To present our clinical experience on embolotherapy of arteriovenous malformations (AVMs) in jaws with acute hemorrhage. MATERIALS AND METHODS Twelve patients with a history of hemorrhage were selected for this study. Continuous interdental sling suture, digital pressure on the extraction socket, and iodoform gauze packed into the socket and fixed with sutures to the adjacent gum were used for temporary hemostasis before embolization. Fiberoptic bronchoscopy was used in all cases to facilitate endotracheal intubation. Absolute ethanol combined with coils was used as method of embolization. RESULTS Eight patients presented with intermittent interdental gum bleeding or controlled hemostasis before embolization. Four patients presented with torrential hemorrhage around the tooth, controlled by continuous pressure on the tooth and bilateral gum for temporary hemostasis. All patients were successfully salvaged before embolization. Ten of 12 patients were cured, and 2 had partial remission. Follow-up ranged from 12 to 26 months (mean, 16.5 months) for all patients, and there was no recurrence of the lesions. CONCLUSIONS The treatment of hemorrhagic AVMs of the jaw requires a multidisciplinary team approach; such cases can be successfully salvaged and stably controlled by embolization with coils and absolute ethanol.
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Affiliation(s)
- Lixin Su
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Han
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfeng Wang
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Gingival bleeding of a high-flow mandibular arteriovenous malformation in a child with 8-year follow-up. Case Rep Pediatr 2015; 2015:745718. [PMID: 25893127 PMCID: PMC4381677 DOI: 10.1155/2015/745718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
Intraosseous arteriovenous malformations (AVMs) in the head and neck region are uncommon. There are several types and they can have a wide range of clinical presentations. Depending on the blood flow through the AVM, the treatment may be challenging for the attending team and may lead to life-threatening hemorrhages. A clinical case report is presented. A 9-year-old girl, seen for gingival bleeding during oral hygiene, was found to have a high-flow AVM located within and around the mandible. Two-stage treatment consisted of intra-arterial embolization followed by intraoral injection of a sclerosing agent 8 weeks later. At the 8-year follow-up, imaging study showed no evidence of recurrent lesion inside or outside the bone. The final outcome is a correct occlusion with a symmetric facial result. This case shows that conservative treatment may be the first treatment option mostly in children. Arteriography and transcortical injection were enough to control the AVM.
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Comprehensive treatment and rehabilitation of a patient with maxillary arteriovenous malformation. J Craniofac Surg 2014; 25:e463-7. [PMID: 25148624 DOI: 10.1097/scs.0000000000001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Arteriovenous malformations (AVMs) of the maxilla are rare and potentially life-threatening conditions that can pose a therapeutic dilemma. We reported the first case of maxillary AVM in a 15-year-old girl who was treated by marginal hemimaxillectomy including overlying palatal mucosa and immediate replantation of the segment after removing the AVM tissues and teeth and covering by a full-thickness pedicled temporal muscle flap rotated into the mouth. Then, this preserved bone underwent distraction osteogenesis and dental implant rehabilitation successfully. This method was previously used for the definitive treatment of mandibular AVMs, and in this case, we applied this method for the first time in maxillary AVMs. In conclusion, this surgical method may be considered as a safe, convenient, and effective treatment and reconstructive modality for such vascular malformations in the maxilla and restores function and symmetry of the jaws while obviating the need for bone harvesting and future major reconstructive operations.
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Colletti G, Valassina D, Bertossi D, Melchiorre F, Vercellio G, Brusati R. Contemporary Management of Vascular Malformations. J Oral Maxillofac Surg 2014; 72:510-28. [DOI: 10.1016/j.joms.2013.08.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
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