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Israrahmed A, Agarwal R, Chauhan G. Endovascular embolisation of a complex mandibular AVM: a hybrid transarterial and transvenous approach. BMJ Case Rep 2023; 16:e251589. [PMID: 36693701 PMCID: PMC9884935 DOI: 10.1136/bcr-2022-251589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Mandibular arteriovenous malformations (AVMs) are rare lesions which can present with life-threatening haemorrhage. Endovascular embolisation can be life saving for these patients. We discuss a patient of mandibular AVM, who initially presented with reports of massive oral bleeding. The lesion was only partially embolised via transarterial route, as the nidus could not be penetrated completely. In view of rebleeding within 72 hours from the same site, a second embolisation procedure was done via combined, transarterial and transvenous approaches. Coils and onyx were used as embolising agents. Complete embolisation was achieved via combined approach. No further bleeding episodes were seen at 1-year follow-up. Endovascular embolisation of mandibular AVMs can be technically challenging and, hence, a sound knowledge of the anatomy as well as the possible modification of technique is essential to achieve complete obliteration of the lesion and to maximise the benefit of embolisation and to avoid major radical surgery.
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Affiliation(s)
| | | | - Gaurav Chauhan
- Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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2
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Resection and immediate reconstruction of two pediatric intraosseous capillary mandibular malformations. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01905-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3
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Scott C, Holden A. Major haemorrhage from oral arteriovenous malformation during pregnancy: a case report. Aust Dent J 2021; 67:178-182. [PMID: 34918340 DOI: 10.1111/adj.12895] [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: 11/25/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
This case report describes the presentation of a pregnant woman, a periodontist, at 39 weeks gestation to The Royal Prince Alfred Hospital emergency department (Sydney, NSW) with major haemorrhage from an oral arteriovenous malformation (AVM) and foetal distress. The lesion had grown rapidly during her pregnancy and she had presented to multiple hospitals and dental practitioners who had failed to diagnose her condition and recognize the potential for major complications for the patient and her baby. Bleeding was controlled with manual pressure while she underwent an emergency Caesarean section followed by emergency angiography and partial embolization of the lesion. The bleeding did not recur, and the lesion continued to regress post-partum. This paper illustrates the diagnostic dilemma of recognizing an AVM and also the potentially disastrous consequences that could occur if a dentist was to embark on extractions or other surgical treatment in the vicinity of such a lesion without realizing its significance.
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Affiliation(s)
- Clm Scott
- Sydney Dental Hospital and Oral Health Services, Sydney, New South Wales, Australia
| | - Acl Holden
- Sydney Dental Hospital and Oral Health Services, Sydney, New South Wales, Australia.,The University of Sydney School of Dentistry, Sydney, New South Wales, Australia.,The University of Toronto Faculty of Dentistry, Toronto, Canada
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Ramakrishnan K, Palanivel I, Narayanan V, Chandran S, Gurram P. Management of vascular malformations in the Oral and maxillofacial region: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:588-599. [PMID: 33400992 DOI: 10.1016/j.jormas.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose is to determine the comprehensive review and the current concepts on the management of vascular malformation and to evaluate the long term outcomes, recurrence and complication rate. METHODS This systematic review followed PRISMA guidelines and registered in PROSPERO (CRD42020173735). The PUBMED, EBSCO, SCOPUS and NDH databases were used to perform a comprehensive search of articles published up until July 2020. The database search identified 1719 articles. After an intricate review, 34 studies were estimated for eligibility. RESULTS A total of 1719 patients with mean age of 27.48 years were treated for vascular malformation in the oral and maxillofacial region. Moderate heterogeneity was observed for the outcome (P = 0.166; 95% CI:1.01-1.46, I2 = 48%). As determined by one-way ANOVA, there was no statistically significant difference between the type of diagnosis and the recurrence (F = 2.313, p = 0.092) and the complication rate (F = 2.112, p = 0.117). CONCLUSION In accordance with the available scientific literature, this review has highlighted the modalities and advancement in the management of vascular malformations. Complications and recurrence were reported in all types of management. It can be avoided by careful diagnosis, pre-operative assessment and treatment planning.
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Affiliation(s)
- Karthik Ramakrishnan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College & Hospital, SRM University, Tamil Nadu, 603203 Chennai, India
| | - Indu Palanivel
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College & Hospital, SRM University, Tamil Nadu, 603203 Chennai, India
| | - Vivek Narayanan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College & Hospital, SRM University, Tamil Nadu, 603203 Chennai, India
| | - Saravanan Chandran
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College & Hospital, SRM University, Tamil Nadu, 603203 Chennai, India
| | - Prashanthi Gurram
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College & Hospital, SRM University, Tamil Nadu, 603203 Chennai, India
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Gegenava BB, Shumakov DV, Osiev AG, Chukumov RM, Bavykin AA. Retrograde transvenous balloon-assisted Onyx embolization of mandibular arteriovenous malformation after hemorrhage. Radiol Case Rep 2018; 14:348-353. [PMID: 30581522 PMCID: PMC6297065 DOI: 10.1016/j.radcr.2018.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 11/03/2022] Open
Abstract
Mandibular arteriovenous malformation (AVM) is a rare lesion, but it often can be presented with life-threatening bleedings. Endovascular treatment of mandibular AVMs has multiple approaches including transarterial embolization, transvenous embolization, direct puncture, and sclerotherapy. In this case study, we present a patient with mandibular AVM complicated by hemorrhage. The patient was treated with transarterial embolization, followed by transvenous sclerotherapy with balloon occlusion of venous outflow. But radical occlusion of AVM was achieved only by transvenous embolization of AVM with Onyx via double lumen balloon, which occluded the venous outflow.
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A massive haemorrhage developing during deciduous tooth extraction in a young child: A case report. Int J Surg Case Rep 2017; 31:237-240. [PMID: 28189988 PMCID: PMC5304235 DOI: 10.1016/j.ijscr.2017.01.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Major haemorrhage developing during oral or maxillofacial surgery is uncommon, but potentially life-threatening. Dental extractions in childhood are common, but blood loss is unusual. CASE PRESENTATION Here, we report a rare case of a complication developing during a trivial deciduous tooth extraction. We focus on the great difference between the preoperative orthopantomography and the maxillo-facial computed tomography obtained post-haemorrhage. DISCUSSION The surgical procedures most commonly associated with acute haemorrhage are orthognathic, oncological, and temporomandibular joint procedures. When acute haemorrhage develops, the surgeon must remain calm, temporarily arrest the bleeding, and ultimately definitively control it. Although ligation of the offending artery, vein, or vascular malformation is clearly the treatment of choice, identifying the offending vessel and gaining adequate access thereto are often difficult. CONCLUSION We emphasise that what we encountered could happen in routine daily practice.
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Karim AB, Lindsey S, Bovino B, Berenstein A. Oral Surgical Procedures Performed Safely in Patients With Head and Neck Arteriovenous Malformations: A Retrospective Case Series of 12 Patients. J Oral Maxillofac Surg 2016; 74:255.e1-8. [DOI: 10.1016/j.joms.2015.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
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Öztürk K, Göde S, Gürsan G, Turhal G, Çınar C, Bozkaya H. Obliteration of a Large Mandibular Arterio-Venous Malformation with Polymethyl Methacrylate Bone Cement. Turk Arch Otorhinolaryngol 2015; 53:80-83. [PMID: 29391986 DOI: 10.5152/tao.2015.820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/04/2015] [Indexed: 11/22/2022] Open
Abstract
Mandibular arteriovenous malformations (AVMs) are rare and potentially life-threatening vascular lesions. Surgery, embolization, or bone cement implantation is an option for the treatment of mandibular AVMs. We present a case of huge mandibular AVM refractory to multiple embolizations of the supplying arteries, which was treated with polymethylmethacrylate (PMMA) bone cement implantation after the extraction of a molar tooth.
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Affiliation(s)
- Kerem Öztürk
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sercan Göde
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gülce Gürsan
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Göksel Turhal
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Celal Çınar
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Halil Bozkaya
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
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Dwivedi AND, Pandey A, Kumar I, Agarwal A. Mandibular arteriovenous malformation: A rare life-threatening condition depicted on multidetector CT angiography. J Oral Maxillofac Pathol 2014; 18:111-3. [PMID: 24959049 PMCID: PMC4065426 DOI: 10.4103/0973-029x.131930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Arteriovenous malformation (AVM) of the mandible is a rare and potentially life-threatening condition which can lead to massive hemorrhage. The following is a description where a large mandibular AVM presented with torrential bleeding following tooth extraction for caries. An orthopantomogram (OPG) was performed which was suggestive of aneurysmal bone cyst or ameloblastoma. A computed tomography (CT) angiography revealed a large mandibular AVM with submandibular extension. It is important for both clinicians and radiologist to be aware of this type of lesion that can have life-threatening complications. It is important to define the anatomical location and the feeder vessels of the entity in detail preoperatively. This communication highlights the common differential and use of multidetector CT (MDCT) angiography along with other imaging modalities to prevent a fatal hemorrhage and arrive at a correct diagnosis.
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Affiliation(s)
- Amit Nandan Dhar Dwivedi
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anubha Pandey
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Arjit Agarwal
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Transarterial embolization of mandibular arteriovenous malformations using ONYX. J Oral Maxillofac Surg 2014; 72:1504-10. [PMID: 24704035 DOI: 10.1016/j.joms.2014.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/13/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE To document the efficacy of ethylene vinyl alcohol copolymer (ONYX; ev3/Covidien, Irvine, CA) in the treatment of arteriovenous malformations (AVMs) of the mandible. MATERIALS AND METHODS A retrospective consecutive series of patients with facial AVMs isolated to the mandible and immediate perimandibular tissue was identified at 2 institutions. The primary treatment modality of transarterial embolization using ONYX was performed by way of the external carotid artery branches. Staged procedures were accomplished until no arteriovenous shunt remained. A 1-year follow-up angiogram was obtained for each patient. RESULTS Three patients, aged 8 (patient 1), 16 (patient 2), and 17 (patient 3) years presented with bleeding from facial AVMs isolated to the mandible. Patient 1 was female and patients 2 and 3 were male. The 2 older patients had loose molar or canine dentition. Transarterial embolization with ONYX achieved complete angiographic closure of the arteriovenous shunt in each patient. A total of 1, 6, and 3 staged embolization procedures were performed in the 3 patients. Patient 2 had mild transient facial numbness after embolization that completely resolved. Patient 3 had loose molars associated with the AVM that were extracted for treatment of intraprocedural bleeding. The 1-year angiographic follow-up data demonstrated durable closure of all 3 lesions. CONCLUSIONS Transarterial embolization of high-flow intraosseus mandibular AVMs was safely accomplished with ONYX in our small retrospective cohort. Complete, durable occlusion was found on the angiogram at 1 year, with clinical stability extending to an average of 3 years. Surgical resection of the AVM was avoided in all 3 patients.
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Aldridge E, Cunningham LL, Gal TJ, Yepes JF, Abadi BJ. Intraosseous venous malformation of the mandible: a review on interdisciplinary differences in diagnostic nomenclature for vascular anomalies in bone and report of a case. J Oral Maxillofac Surg 2011; 70:331-9. [PMID: 21798650 DOI: 10.1016/j.joms.2011.03.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 03/12/2011] [Accepted: 03/15/2011] [Indexed: 12/01/2022]
Affiliation(s)
- Eron Aldridge
- Division of Oral and Maxillofacial Surgery, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
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12
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Lemound J, Brachvogel P, Götz F, Rücker M, Gellrich NC, Eckardt A. Treatment of Mandibular High-Flow Vascular Malformations: Report of 2 Cases. J Oral Maxillofac Surg 2011; 69:1956-66. [DOI: 10.1016/j.joms.2010.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 07/27/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
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13
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Menon S, Roy Chowdhury SK, Mohan C. Arteriovenous Malformation in Mandible. Med J Armed Forces India 2011; 61:295-6. [PMID: 27407786 DOI: 10.1016/s0377-1237(05)80182-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 01/22/2004] [Indexed: 11/16/2022] Open
Affiliation(s)
- Suresh Menon
- Associate Professor, Oral and Maxillofacial surgery, Armed Forces Medical College, Pune
| | - S K Roy Chowdhury
- Classified Specialist, Oral and Maxillofacial surgery, Army Dental Centre
| | - Chandra Mohan
- Senior Advisor, Radiodiagnosis and Interventional Vascular Radiology, Army Hospital, R&R, Delhi Cantt
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14
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Shum JW, Clayman L. Resection and immediate reconstruction of a pediatric vascular malformation in the mandible: Case report. ACTA ACUST UNITED AC 2010; 109:517-24. [DOI: 10.1016/j.tripleo.2009.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/11/2009] [Accepted: 10/12/2009] [Indexed: 11/30/2022]
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15
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Treatment of Arteriovenous Malformation of the Mandible With Resection and Immediate Reconstruction. J Oral Maxillofac Surg 2010; 68:658-63. [DOI: 10.1016/j.joms.2007.12.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 10/24/2007] [Accepted: 12/20/2007] [Indexed: 11/17/2022]
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16
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Lai QG, Li GJ, Yuan KF, Xu X, Wang YZ, Li YL, Yang ZJ, Luo SL. Transarterial embolization of a high-flow maxillary arteriovenous malformation fed by multiple arteries. ACTA ACUST UNITED AC 2009; 108:e17-21. [DOI: 10.1016/j.tripleo.2009.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 03/06/2009] [Indexed: 11/24/2022]
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17
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Bouloux GF, Perciaccante VJ. Massive Hemorrhage During Oral and Maxillofacial Surgery: Ligation of the External Carotid Artery or Embolization? J Oral Maxillofac Surg 2009; 67:1547-51. [PMID: 19531434 DOI: 10.1016/j.joms.2009.03.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 03/08/2009] [Indexed: 11/17/2022]
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Granata F, De Ponte F, Pandolfo I, Pitrone A, Vinci S, Blandino A, Longo M. Arteriovenous fistula of the mandible simulating an odontogenic cyst. A case report. Interv Neuroradiol 2007; 13:385-8. [PMID: 20566108 DOI: 10.1177/159101990701300410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 11/12/2007] [Indexed: 11/16/2022] Open
Abstract
SUMMARY We describe a rare case of mandibular highflow arteriovenous malformation (AVM) mimicking an odontogenic cyst in a young man. The diagnosis of mandibular AVM was made by CT angiography and confirmed by digital subtraction angiography. CT scan showed the extent of mandibular bone alteration and a double enlarged mandibular canal on the same side. An AVM containing a large aneurysm was demonstrated by CT angiography.The mandibular AVM was successfully treated by endovascular therapy with Guglielmi detachable coils. On panoramic radiogram, mandibular AVMs can appear as cystic lesions without pathognomonic features. Several benign and malignant tumours of this anatomical region must be considered in the differential diagnosis.We emphasize the radiological sign of double enlarged mandibular canal and the diagnostic role of CT, particularly CT angiography, to discriminate a mandibular AVM from neoplastic entities of this region, sparing the risks of a needle biopsy.
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Affiliation(s)
- F Granata
- Department of Radiology - University of Messina, Italy -
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19
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Fan X, Zhang Z, Zhang C, Tang Y, Hu Y, Mao Q, Qiu W. Direct-puncture embolization of intraosseous arteriovenous malformation of jaws. J Oral Maxillofac Surg 2002; 60:890-6; discussion 896-7. [PMID: 12149733 DOI: 10.1053/joms.2002.33858] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Our goal was to report our experience with direct-puncture embolization of intraosseous arteriovenous malformations (AVMs). PATIENTS AND METHODS Three cases of AVM in the mandible and 2 cases of AVM in the maxilla comprised this study group. The patients were embolized with fiber coils through direct puncture, and the coils were placed directly into the center of the intraosseous lesion, in some cases in conjunction with polyvinyl alcohol foam and N-butyl-2-cyanoacrylate through vascular access. RESULTS The acute arterial bleeding was controllable in 3 patients. The other 2 patients had pericoronal oozing bleeding and a warm soft pulsative mass on the left face, respectively; their symptoms and signs improved greatly. The pericoronal oozing of blood in all patients disappeared during a 3- to 13-month follow-up, and new bone formation was found on the follow-up radiography. CONCLUSIONS The embolization of the AVM of jaws by direct percutaneous puncture in conjunction with endovascular therapy is effective and safe, but longer follow-up is required to determine the true efficacy of this method of treatment.
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Affiliation(s)
- Xindong Fan
- Department of Radiology, Ninth People's Hospital, Shanghai Second Medical University, Shanghai, People's Republic of China.
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20
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Brusati R, Galioto S, Biglioli F, Goisis M. Conservative treatment of arteriovenous malformations of the mandible. Int J Oral Maxillofac Surg 2001; 30:397-401. [PMID: 11720041 DOI: 10.1054/ijom.2001.0120] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A modified technique is reported on the treatment of arteriovenous malformations in the mandibular body. The technique consists of highly selected embolization and piecemeal removal of the lesion through burred holes made in the cortex. This way the mandible and the teeth may be saved in selected patients.
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Affiliation(s)
- R Brusati
- Department of Maxillo-Facial Surgery, San Paolo University Hospital, Milan, Italy
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21
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Motamedi MH, Behnia H, Motamedi MR. Surgical technique for the treatment of high-flow arteriovenous malformations of the mandible. J Craniomaxillofac Surg 2000; 28:238-42. [PMID: 11110157 DOI: 10.1054/jcms.2000.0139] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The high-flow intraosseous arteriovenous malformation is a problematic vascular lesion which may affect bone and the dentition. Variable clinical presentations of this anomaly have resulted in a gamut of treatment modalities being reported ranging from simple curettage, resection, radiotherapy, sclerosing injections, and various forms of embolization, to immediate replantation of the resected segments. Embolization techniques alone have not been universally successful and have often resulted in rapid development of collaterals from surrounding vessels. Definitive treatment has usually involved complete surgical resection (when feasible) either alone, or in combination with other modalities such as embolization. Jaw resection, however, is deforming and leaves a defect often requiring subsequent reconstruction of the hard and soft tissues and replacement of any teeth lost with the resected segment. We report a surgical technique to treat mandibular arteriovenous malformations, which permits ligation of the feeding vessels and provides access allowing for complete removal of the intraosseous lesion. At the same time it not only prevents facial deformity by preserving the mandibular bone and oral soft tissue, but also, and more importantly, may preserve the dentition as well.
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Affiliation(s)
- M H Motamedi
- Department of Oral and Maxillofacial Surgery, Trauma Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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22
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Kacker A, Heier L, Jones J. Large intraosseous arteriovenous malformation of the maxilla - a case report with review of literature. Int J Pediatr Otorhinolaryngol 2000; 52:89-92. [PMID: 10699245 DOI: 10.1016/s0165-5876(99)00290-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Large intraosseous arteriovenous malformations (AVM) of the maxilla are rare lesions, which are probably hamartomas. We report a case of an 8-year-old child who presented with exsanguinating hemorrhage after an attempted dental biopsy. The management of dental intraosseous AVMs includes transarterial embolization and direct intralesional injection of liquid acrylic (NBCA). This approach avoids mutilating surgery and its sequelae in children. We present this case for its rarity and the intralesional use of acrylic glue in its management.
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Affiliation(s)
- A Kacker
- Department of Otorhinolaryngology, Weill College of Medicine of Cornell University, Starr Building, Suite 541, 520 E 70th St., New York, NY 10021, USA
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Kiyosue H, Mori H, Hori Y, Okahara M, Kawano K, Mizuki H. Treatment of mandibular arteriovenous malformation by transvenous embolization: A case report. Head Neck 1999; 21:574-7. [PMID: 10449675 DOI: 10.1002/(sici)1097-0347(199909)21:6<574::aid-hed12>3.0.co;2-d] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Arteriovenous malformations (AVMs) of the mandible are relatively rare and potentially life-threatening lesions. Treatment is usually difficult. This study presents a case with high-flow AVM of the mandible in which most of the AVM were occluded by transvenous coil embolization. METHODS Transvenous embolization using several size 57 microcoils and 3 Gianturco coils was performed through a right femoral vein access. The small residual AVM was occluded by superselective transarterial injection of cyanoacrylate. RESULTS Angiography after embolization showed almost complete obliteration of AVM. Panoramic radiograph 2 years after treatment confirmed reossification. There was no recurrence of the symptoms in a follow-up evaluation 2 years later. CONCLUSION Transvenous coil embolization may be a safer and more effective method in the treatment of mandibular AVM.
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Affiliation(s)
- H Kiyosue
- Department of Radiology, Oita Medical University, 1-1 Hasama, Oita, Japan
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24
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David JS, Bertrand E, Chavanis N, Borne J, Ocquidant P. [Severe hemorrhage from rupture of an intra-oral arteriovenous malformation]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:355-7. [PMID: 10228674 DOI: 10.1016/s0750-7658(99)80061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the case of a 47-year-old woman with a sudden, spontaneous exsanguinating haemorrhage from an arteriovenous malformation of the mandible. The diagnosis was obtained with a contrast enhanced CT-scan and a digital subtraction angiography. As arterial embolisation was not available the lesion was treated surgically.
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Affiliation(s)
- J S David
- Service de réanimation neurochirurgicale, CH Sud Réunion, La Réunion, France
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