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Shen Y, Wang D, Su L, Fan X, Yang X. Ethanol embolotherapy of mandibular arteriovenous malformation-induced acute oral hemorrhage after tooth extraction. Head Neck 2024; 46:E80-E83. [PMID: 38818845 DOI: 10.1002/hed.27833] [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] [Received: 12/12/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Mandibular arteriovenous malformation (AVM) is rare. Our work aims to introduce the ethanol embolization of a patient suffering from acute oral hemorrhage induced by mandibular AVM. METHODS A 35-year-old woman without coagulopathy underwent tooth extraction, and the acute oral bleeding occurred intraoperatively. Imaging examinations indicated the enhancement of vascular mass with bone destruction inside the mandible. Angiography finally confirmed the high blood flow nature and the diagnosis of AVM. RESULTS During the interventional procedure, the coils were first applied into the dilated outflowing vein to slow down the blood flow rate of mandibular AVM. Absolute ethanol was injected in a multi-bolus modality to destroy the nidus of AVM. Her mandibular lesion had been stable in the 12-month re-examined angiography, no further bleeding occurred during the period. CONCLUSIONS Ethanol embolotherapy was a less invasive, more precise, and quick-action approach managing AVM of the jaw and related emergency medicine.
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Affiliation(s)
- Yuchen Shen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixin Su
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitao Yang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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2
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Shen Y, Su L, Wang D, Fan X. Overview of peripheral arteriovenous malformations: From diagnosis to treatment methods. J Interv Med 2023; 6:170-175. [PMID: 38312130 PMCID: PMC10831390 DOI: 10.1016/j.jimed.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 02/06/2024] Open
Abstract
Based on the latest classification by the International Society for the Study of Vascular Anomalies in 2018, vascular malformations (VMs) can be categorized into simple, combined VMs of major named vessels, and VMs associated with other anomalies. Simple VMs include lymphatic, venous, capillary, and arteriovenous malformations (AVMs). AVMs represent disorders of direct arteriovenous shunts caused by the absence of a capillary bed between the involved arteries and veins. This abnormal vascular communication causes arterial blood to accumulate in the venous vessels, thus resulting in venous hypertension and characteristic clinical manifestations, such as pulsation, tremors, and elevated temperature. AVMs can occur sporadically or as manifestations of syndromic lesions and are considered among the most complex and challenging VMs. The diagnosis and treatment of AVMs can vary depending on the lesion location and associated clinical symptoms, thus complicating their management. Herein, we discuss peripheral AVMs in terms of their clinical manifestations, imaging examinations, and staging systems to provide a comprehensive reference for the treatment, evaluation methods, and follow-up procedures for this vascular anomaly.
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Affiliation(s)
| | | | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, 200011, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, 200011, Shanghai, China
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3
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Shen Y, Wang Z, Yang X, Zheng L, Wen M, Han Y, Li X, Zhang L, Wang J, You J, Jiang C, Su L, Fan X, Wang D. Novel classification for simple peripheral arteriovenous malformations based on anatomic localization: Prevalence data from the tertiary referral center in China. Front Cardiovasc Med 2022; 9:935313. [PMID: 35942181 PMCID: PMC9356220 DOI: 10.3389/fcvm.2022.935313] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background In absence of the large-sample study of simple peripheral arteriovenous malfomations (pAVM), we aimed to perform the epidemiological analysis of over 1,000 simple pAVM patients from our center in the past 5 years, and establish a novel classification based on the anatomical localization of the primary lesion. Results Between March 27, 2016, and March 31, 2021, Chinese patients who were diagnosed with simple pAVM were taken into account. Those who suffered from simple arteriovenous malformations of the central nervous system (cnsAVM), combined types of AVM, and syndromes, such as CLOVES syndrome, etc. were all excluded from this study. A total of 1,070 simple pAVM patients were screened out. All of the simple pAVM patients were diagnosed by clinical manifestations and imaging examinations. Demographic data were obtained from the National Bureau of Statistics of China. The 5-year prevalence of simple pAVM was about (2.15–6.60) /1,000,000 population. The male-female ratio was approximately 1.22:1. The pAVM inpatients that were included in the age group of 21~30 years old had the highest constituent ratio (P = 0.01). The classification included four groups: Type I (primarily occurring in soft tissue); Type II (primarily occurring in bone); Type III (primarily occurring in the viscus) and Type IV (simple pAVM coexisting with CNS lesions). There were two subtypes of Type I: the A subtype (involving one major anatomical region) and the B subtype (involving two or more major anatomical regions); two subtypes of Type II: the A subtype (the cortex was intact) and the B subtype (the lesion had broken through the cortex). Generally, 657 patients were classified as Type IA (61.4%), 232 patients were Type IB (21.7%), 82 patients were Type IIA (7.7%) and 79 were categorized as Type IIB (7.4%); the number of patients who had Type III and Type IV pAVM were 9 (0.8%) and 11 (1.0%), respectively. The clinical manifestations and diagnostic standards for each type were also systematically summarized. Conclusions Prevalence data for simple pAVM were analyzed, and a novel classification was proposed based on the anatomy of the lesions. The present work was expected to facilitate the diagnosis of simple pAVM in clinical works.
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Sun Y, Su L, Rao Y, Wang Z, Wang D, Fan X, Cai R. Mosaic GNA11 mutations and a second hit in KRAS in Phakomatosis pigmentovascularis are associated with intraosseous arteriovenous malformations in the jaw. J Eur Acad Dermatol Venereol 2022; 36:e484-e486. [PMID: 35080323 DOI: 10.1111/jdv.17973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Yi Sun
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Lixin Su
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Yamin Rao
- Department of pathology, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhenfeng Wang
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Deming Wang
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Xindong Fan
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Ren Cai
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China
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5
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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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Nilesh K, Shah S, Gautam A, Thorat S. Uncontrolled bleeding during tooth extraction from an undiagnosed arteriovenous malformation. BMJ Case Rep 2021; 14:e236983. [PMID: 34446508 PMCID: PMC8395353 DOI: 10.1136/bcr-2020-236983] [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] [Accepted: 08/06/2021] [Indexed: 11/04/2022] Open
Abstract
Arteriovenous malformations (AVMs) are rare congenital disorders of vascular morphogenesis. These lesions are characterised by high vascular flow with risk of severe bleeding from accidental trauma or surgical manipulation. Although infrequent, potentially life-threatening and fatal oral bleeding has been reported during extraction of tooth associated with AVM. This paper presents a case of uncontrolled bleeding in an adult female patient undergoing mandibular anterior tooth extraction. The bleeding was related to undiagnosed soft tissue AVM in gingivobuccal space. Management of the case with review of previously reported similar cases is presented.
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Affiliation(s)
- Kumar Nilesh
- Oral and Maxillofacial Surgery, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - Swenil Shah
- Department of Radiology, RCSM Government Medical College, Kolhapur, India
| | - Amol Gautam
- Department of Radiodiagnosis, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - Sagar Thorat
- Department of Oral and Maxillofacial Surgery, Krishna Deemed University, Karad, India
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7
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Minimal Invasive Surgical Management of Familial Arteriovenous Malformation. Case Rep Dent 2021; 2021:5564470. [PMID: 34221516 PMCID: PMC8211530 DOI: 10.1155/2021/5564470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Familial arteriovenous malformations are exceedingly rare. They are often noted at birth. They can also present during childhood or adolescence. Sclerotherapy has proven to have a favorable outcome. Case Presentation. The present case report describes the treatment of arteriovenous malformations on the tongue, labial mucosa, and vermilion border in siblings treated with boiling saline injections. Conclusion Sclerotherapy using boiling saline had shown to effectively treat arteriovenous malformations in the oral region without any significant morbidity.
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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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Ravula P, Rangachari S, Susarla R, Sambari L, Jammula SS. Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible. Indian J Plast Surg 2018; 51:222-230. [PMID: 30505095 PMCID: PMC6219352 DOI: 10.4103/ijps.ijps_13_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subsequent reconstructions. With the advent of advanced multidisciplinary techniques aimed at definitive therapy, surgical resection and primary reconstruction can provide an ideal anatomical and functional cure. There are no previous reports on primary resection and reconstruction for life-threatening haemorrhage from high flow AVM of the mandible. Aim: We discuss our approach aimed at definitive therapy in life-threatening intraoral bleeding from large high flow AVM of the mandible. Subjects and Methods: Four patients were managed for life-threatening intraoral bleeding during 2015–2017. Compression was applied over the bleeding point before the airway could be secured by endotracheal tube. Under general anaesthesia, the external carotid artery (ECA) was temporarily occluded using an umbilical tape loop ligature to control the bleeding. Emergency selective embolisation was done, followed by curative resection and primary mandible reconstruction using free fibula flap. Outcome assessed. Results: Temporary occlusion of the ECA successfully controlled the bleeding immediately and facilitated selective embolisation and definitive therapy. All the four cases were successfully reconstructed with a good outcome. There was no recurrence during the follow-up period. Conclusion: In life-threatening intraoral bleeding from large high flow AVM of the mandible, emergency selective embolisation followed by curative resection and primary reconstruction is safe in achieving an ideal cure.
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Affiliation(s)
- Parvathi Ravula
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Srikanth Rangachari
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rammurti Susarla
- Department of Radiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Laxman Sambari
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Srinivas Saraswathi Jammula
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Fábián Z, Szabó G, Petrovan C, Horváth KU, Babicsák B, Hüttl K, Németh Z, Bogdán S. Intraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms. Oral Maxillofac Surg 2018; 22:241-247. [PMID: 29651653 DOI: 10.1007/s10006-018-0691-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
Intraosseous vascular malformations (VascM) of the facial skeleton are rare entities, raising difficulties even today in their treatment. We present a case for zygomatic intraosseous venous malformation of traumatic etiology with growth dynamics presentation and a multidisciplinary treatment approach, with intravascular embolization surgical ablation and primary reconstructruction using a titanium patient-specific implant (PSI), and a review of the literature for intraosseous vascular lesions of the facial skeleton focusing on the diagnostic syntagms used by the involved medical personnel, to shed light on the confusions over these terms.
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Affiliation(s)
- Zoltán Fábián
- University of Medicine and Pharmacy, Târgu Mureș, Romania
| | - György Szabó
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary
| | - Cecilia Petrovan
- Department of Oral and Maxillofacial Surgery, County Clinical Emergency Hospital, 1 decembrie 1918 Blvd. 26-28, 540011, Târgu Mureș, Romania
| | - Karin Ursula Horváth
- Department of Ophthalmology, Mureș County Clinical Hospital, Márton Áron st. 26, 540058, Târgu Mureș, Romania
| | - Botond Babicsák
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary
| | - Kálmán Hüttl
- Heart and Vascular Center, Semmelweis University, Városmajor st. 68, Budapest, 1122, Hungary
| | - Zsolt Németh
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary
| | - Sándor Bogdán
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary.
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11
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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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12
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Do YS, Park KB. Special Consideration for Intraosseous Arteriovenous Malformations. Semin Intervent Radiol 2017; 34:272-279. [PMID: 28955116 DOI: 10.1055/s-0037-1605368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Intraosseous arteriovenous malformations (AVMs) have been associated with distortion, hypertrophy, osteolytic skeletal changes, bleeding, leg length discrepancy, and pathologic fracture. Computed tomography or magnetic resonance imaging is helpful in the evaluation of the extent and depth of intraosseous AVMs and associated soft-tissue AVMs. Treatment approaches can differ, depending on the angiographic classification. Embolotherapy with ethanol, coils, or n-butyl cyanoacrylate is the primary treatment for symptomatic intraosseous AVMs, and the goal of treatment is symptom improvement with few complications.
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Affiliation(s)
- Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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13
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Kaderbhai J, Breik O, Heggie AA, Penington AJ. High-flow paediatric mandibular arteriovenous malformations: case reports and a review of current management. Int J Oral Maxillofac Surg 2017; 46:1650-1655. [PMID: 28705626 DOI: 10.1016/j.ijom.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/02/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
High-flow vascular malformations in the paediatric population are potentially life-threatening and are challenging to treat. This paper describes the management of three cases of mandibular arteriovenous malformations and reviews the contemporary management options for these serious lesions.
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Affiliation(s)
- J Kaderbhai
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia
| | - O Breik
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia
| | - A A Heggie
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia.
| | - A J Penington
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia
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14
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Shah K, Srinivasan B, Ethunandan M, Pratt C. Arteriovenous malformation of the jaws: a black hole for the GDP – a case report. ACTA ACUST UNITED AC 2017; 44:444-6. [DOI: 10.12968/denu.2017.44.5.444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kunal Shah
- PGDip Primary Dental Care, Senior House Officer, St Richard's Hospital, Chichester
| | | | | | - Clive Pratt
- Consultant Oral and Maxillofacial Surgeon, St Richard's Hospital, Chichester, PO19 6SE, UK
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15
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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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16
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Yeh CH, Wu YM, Chen YL, Wong HF. Contralateral de novo intraosseous arteriovenous malformation in a child with arteriovenous malformation of mandible treated by endovascular embolotherapy. A case report. Interv Neuroradiol 2012; 18:484-9. [PMID: 23217644 DOI: 10.1177/159101991201800415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 08/12/2012] [Indexed: 11/15/2022] Open
Abstract
We describe our experience of the development of contralateral de novo intraosseous AVMs in a ten-year-old girl with AVMs of the mandible who underwent endovascular embolotherapy. She initially presented with intermittent oral bleeding. Computed tomography and digital subtraction angiography demonstrated intraosseous AVMs within the right mandible. The AVMs were treated by transosseous direct-puncture and transarterial embolization with Guglielmi detachable coils and n-butyl cyanoacrylate glue. However, de novo intraosseous AVMs developed within the previously healthy contralateral mandible and resulted in dangerous oral bleeding. Therefore, we suggest regular follow-up and prompt retreatment of any residual mandibular AVMs in patients undergoing endovascular or surgical treatment to prevent subsequent development of "secondary" AVMs and life-threatening oral bleeding.
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Affiliation(s)
- C-H Yeh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan
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17
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Pekkola J, Lappalainen K, Vuola P, Klockars T, Salminen P, Pitkäranta A. Head and neck arteriovenous malformations: results of ethanol sclerotherapy. AJNR Am J Neuroradiol 2012; 34:198-204. [PMID: 22766677 DOI: 10.3174/ajnr.a3180] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Peripheral AVM is a locally aggressive disease with a high tendency to recur; its treatment is complex, especially in the anatomically delicate head and neck area. Here, we report results of ethanol sclerotherapy for head and neck AVM and discuss its potential use for peripheral AVM. MATERIALS AND METHODS We retrospectively assessed degree of AVM eradication, complications, and clinical or imaging signs of recurrence for 19 patients treated with ethanol sclerotherapy for head and neck AVM (1 intraosseous, 18 soft-tissue AVMs). RESULTS Of the 19 patients, 11 had complete eradication of arteriovenous shunting at DSA, with 1 recurrence (mean follow-up 15 months), and for 7 patients, treatment is ongoing. During 59 treatment sessions, 12 patients experienced 14 complications, 1 leading to permanent functional damage. CONCLUSIONS Ethanol sclerotherapy has potential for complete eradication of head and neck AVM with low recurrence within the first year after completion of treatment. Complete eradication may require several treatment sessions during which complications should be minimized with careful techniques.
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Affiliation(s)
- J Pekkola
- Department of Radiology, University of Helsinki and HUS Radiology, Helsinki, Finland.
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18
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Zhu C, Zhu HG, Zhang ZY, Wang LZ, Zheng JW, Ye WM, He Y, Wang YA. Intraosseous Venous Malformations of the Facial Bone: A Retrospective Study in 11 Patients. Phlebology 2012; 28:257-63. [DOI: 10.1258/phleb.2011.011115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: To investigate the clinical symptoms, computed tomography (CT) features and treatments of intraosseous venous malformations (IVM) that occur in the facial bone. Methods and Results: Eleven patients with facial IVM were treated with two surgical techniques, excision ( n = 4) or curettage ( n = 7). No recurrence was encountered at follow-up (45.8 ± 16.0 months). Postoperative deformities were left in two paediatric patients who were treated with excision. Conclusions: The diagnosis of IVM can be difficult and is mainly based on clinical symptoms and CT features. IVM should be differentiated from other lesions, including ameloblastoma, odontogenic cysts, osteosarcoma, aneurysmal bone cysts and arteriovenous malformations, among others. Conventional block biopsy should be replaced by fine needle aspiration cytology for further diagnosis. Curettage is a more appropriate method for IVM compared with excessive en-bloc osteotomy, while transosseous embolo-sclerotherapy may be a promising alternative method. Finally, the terminological confusion between ‘intraosseous haemangioma’ and ‘intraosseous venous malformation’ should be avoided according to the binary classification.
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Affiliation(s)
- C Zhu
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology
| | - H G Zhu
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology
| | - Z Y Zhang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology
| | - L Z Wang
- Department of Oral Pathology, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - J W Zheng
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology
| | - W M Ye
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology
| | - Y He
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology
| | - Y A Wang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology
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19
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Shailaja SR, Manika, Manjula M, Kumar LV. Arteriovenous malformation of the mandible and parotid gland. Dentomaxillofac Radiol 2012; 41:609-14. [PMID: 22282511 DOI: 10.1259/dmfr/47383305] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Arteriovenous malformations (AVMs) of the jaws are relatively rare, with fewer than 200 cases reported in the literature. Their real importance lies in their potential to result in exsanguination, which usually follows an unrelated treatment, such as tooth extraction, surgical intervention, puncture wound or blunt injury in involved areas, with the dentist unaware of the existence of the AVM. The present case illustrates an AVM in an 18-year-old female with swelling on the right side of the face. This case report is unique because although there was no history of bleeding episodes, thorough examination and investigation diagnosed it as high-flow vascular malformation. We ascertain the importance of dentists' awareness of the fatal outcome of these lesions and emphasize that, prior to performing any procedure, necessary investigations should always be done.
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Affiliation(s)
- S R Shailaja
- Department of Oral Medicine and Radiology, SGT Dental College, Haryana, India.
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20
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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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21
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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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22
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Koshy CG, Keshava SN, Moses V, Sen S. Case report: Combined transarterial and direct approaches for embolization of a large mandibular arteriovenous malformation. Indian J Radiol Imaging 2011; 21:6-9. [PMID: 21431023 PMCID: PMC3056373 DOI: 10.4103/0971-3026.76044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Arteriovenous malformations (AVMs) that involve the mandible are difficult lesions to treat, with traditional options being surgery and embolization. This article describes a large mandibular AVM that was treated with embolization using transarterial as well as direct puncture approaches. Follow-up imaging showed thrombosis of the vascular spaces of the malformation. There were no complications. The patient is doing well and is on follow-up.
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23
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Parihar A, Tomar S, Phadke RV. Direct sac puncture and glue embolization of intraosseous AVM of the maxilla. Int J Oral Maxillofac Surg 2011; 40:749-52. [PMID: 21257292 DOI: 10.1016/j.ijom.2010.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 11/03/2010] [Accepted: 12/16/2010] [Indexed: 11/17/2022]
Abstract
The authors report an intraosseous maxillary arteriovenous malformation (AVM) treated with direct sac injection of n-butyl-2-cyanoacrylate and transarterial embolization. The case is presented because of its rarity and the efficacy of direct puncture glue embolization.
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Affiliation(s)
- A Parihar
- Department of Radiodiagnosis and Imaging, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India.
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24
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Zheng JW, Zhou Q, Yang XJ, Wang YA, Fan XD, Zhou GY, Zhang ZY, Suen JY. Treatment guideline for hemangiomas and vascular malformations of the head and neck. Head Neck 2010; 32:1088-98. [PMID: 19924783 DOI: 10.1002/hed.21274] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Vascular anomalies are among the most common congenital and neonatal dysmorphogenesis, which are separated into hemangiomas and vascular malformations. They can occur in various areas throughout the body, with 60% being located in the head and neck. The true mechanism of pathogenesis of vascular anomalies is still unclear. Various treatment methods have been reported, and there are still controversies over the selection of different treatment modalities. Based on the clinical and basic research and current literature, the Chinese Division of Oral and Maxillofacial Vascular Anomalies formulated a treatment guideline for hemangiomas and vascular malformations of the head and neck, which will be modified and updated periodically based on new medical evidence and research.
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Affiliation(s)
- Jia Wei Zheng
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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25
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Extremity Arteriovenous Malformations Involving the Bone: Therapeutic Outcomes of Ethanol Embolotherapy. J Vasc Interv Radiol 2010; 21:807-16. [DOI: 10.1016/j.jvir.2010.01.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/01/2010] [Accepted: 01/26/2010] [Indexed: 01/25/2023] Open
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Liu D, Ma X, Zhao F, Zhang J. Intraosseous embolotherapy of central arteriovenous malformations in the jaw: long-term experience with 8 cases. J Oral Maxillofac Surg 2009; 67:2380-7. [PMID: 19837306 DOI: 10.1016/j.joms.2009.04.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 02/02/2009] [Accepted: 04/19/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the long-term effects of direct intraosseous histoacryl embolotherapy on central arteriovenous malformations (AVMs) of the jaw. MATERIALS AND METHODS Eight patients with central AVMs of the jaw (3 in the maxilla and 5 in the mandible) were treated with direct intraosseous histoacryl injection. These AVMs exhibited cystic radiolucency, with (n = 5) or without (n = 3) honeycombed component. On angiography, all the AVMs exhibited a large intraosseous nidus with multiple suppliers and drainages. The intraosseous lesions were percutaneously punctured with an 18- to 20-gauge needle, and NBCA diluted 30% to 40% with iodized oil was injected during venous compression. RESULTS Postembolic arteriograms showed that all the AVMs were completely or nearly completely devascularized after single or multiple injections at the initial treatment. The follow-up period ranged from 3 to 8 years. Two AVMs experienced postembolic curettage and were anatomically cured. Three AVMs were anatomically cured after 1 to 3 sessions of embolotherapy. The other 3 AVMs were clinically cured after 1 (n = 2) to 4 (n = 1) sessions of embolotherapy. There were no procedure-related severe complications. CONCLUSIONS Direct intraosseous glue embolotherapy can be a simple and safe technique for endovascular management of central AVMs in the jaw and is particularly effective in an emergency. Complete reossification of the intraosseous nidus can be anticipated if a complete occlusion is obtained.
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Affiliation(s)
- Denggao Liu
- Department of Oral Radiology, Peking University, School and Hospital of Stomatology, Beijing, China.
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27
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de Aguiar Soares Carneiro SC, Batista LL, do Egito Vasconcelos BC, Maranhão CA, Panazzolo G, Queiroz IV, Júnior RM. Massive Oral Hemorrhage Due To Mandibular Arteriovenous Malformation Treated With Percutaneous Approach—A Case Report. J Oral Maxillofac Surg 2009; 67:2525-8. [DOI: 10.1016/j.joms.2009.04.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 04/07/2009] [Accepted: 04/21/2009] [Indexed: 11/29/2022]
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28
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Buiret G, Feugier P, Plouin-Gaudon I, Disant F, Faure F. Management of an arteriovenous fistula with two nidus between the inferior alveolar artery and the external jugular vein. Head Neck 2009; 31:1377-80. [DOI: 10.1002/hed.21015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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29
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Fan XD, Su LX, Zheng JW, Zheng LZ, Zhang ZY. Ethanol embolization of arteriovenous malformations of the mandible. AJNR Am J Neuroradiol 2009; 30:1178-83. [PMID: 19270102 DOI: 10.3174/ajnr.a1539] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Absolute ethanol was reported as an effective embolization of arteriovenous malformations (AVMs), but its use to treat AVMs in the mandible is not yet well established. Here, we present our clinical experience on treatment of mandibular AVMs with absolute ethanol. MATERIALS AND METHODS Eight consecutive patients with symptomatic AVMs of the mandible between August 2007 and September 2008 were enrolled in this study group. Among them, 6 patients underwent direct puncture embolization with absolute ethanol combined with coils, 1 patient underwent direct puncture embolization with absolute ethanol only, and the last patient had transarterial embolization with absolute ethanol alone. The use of coils decreased the flow and volume of the nidus, and then absolute ethanol embolization was directed against and obliterated the nidus completely. The procedure was performed with the patients under general anesthesia with nasal intubation, and the vital signs of the patients were constantly monitored during the injection of absolute ethanol. The total amount of absolute ethanol used per session was less than 1 mL/kg of body weight. RESULTS A total of 11 ethanol embolizations were performed on 8 patients, including 3 sessions with transarterial microcatheterization and 8 with direct puncture embolization. A venogram and control arteriogram performed immediately after the procedure were both obtained, which documented a significant thrombosis of the lesion in all patients. Follow-up examinations revealed that oral bleeding was controlled, the expansion of the external jugular vein in 5 cases was obliterated, and satisfactory shrinkage of the facial swelling was achieved. Follow-up angiography (mean, 4.2 months) was available in 4 patients, and there was no angiographic recurrence of the lesions. There were 3 cases with minor complications. CONCLUSIONS On the basis of our experience, treatment of AVMs in the mandible with absolute ethanol is a feasible, safe, and highly effective method.
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Affiliation(s)
- X D Fan
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
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30
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Siniscalchi EN, Minutoli F, Catalfamo L, Romano F, Longo M, De Ponte FS. Intraosseous mandibular artero-venous malformations: Case report. J Craniomaxillofac Surg 2009; 37:106-9. [DOI: 10.1016/j.jcms.2008.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 10/06/2008] [Accepted: 10/09/2008] [Indexed: 11/30/2022] Open
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31
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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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32
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Sakkas N, Schramm A, Metzger MC, Berlis A, Schmelzeisen R, Otten JE, Hohlweg-Majert B. Arteriovenous malformation of the mandible: a life-threatening situation. Ann Hematol 2007; 86:409-13. [PMID: 17285275 DOI: 10.1007/s00277-007-0261-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 01/11/2007] [Indexed: 11/26/2022]
Abstract
Arteriovenous malformation (AVM) of the mandible is not only a rare entity, but also one that can be potentially life threatening due to massive haemorrhage. The authors describe three cases of children with AVM of the mandible.
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Affiliation(s)
- Nikolaos Sakkas
- Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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33
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Nekooei S, Hosseini M, Nazemi S, Talaei-Khoei M. Embolisation of arteriovenous malformation of the maxilla. Dentomaxillofac Radiol 2006; 35:451-5. [PMID: 17082338 DOI: 10.1259/dmfr/24503595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We describe a 20-year-old male patient who presented with gingival bleeding. Physical examination showed gingival swelling of the right maxilla and loosening of the molar teeth. The initial diagnosis of gingivitis was made, but further examination revealed a lytic lesion of the maxilla. On suspicion of fibrous dysplasia, biopsy was attempted but was unsuccessful due to severe haemorrhage. Further evaluation showed palpable and audible bruit on the gingiva, which caused the suspicion of vascular malformation. Angiography was performed and demonstrated arteriovenous malformation (AVM). Embolisation therapy with polyvinyl alcohol was performed. Post-embolisation angiogram demonstrated complete obliteration of the lesion.
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Affiliation(s)
- S Nekooei
- Department of Radiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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34
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Kademani D, Costello BJ, Ditty D, Quinn P. An alternative approach to maxillofacial arteriovenous malformations with transosseous direct puncture embolization. ACTA ACUST UNITED AC 2004; 97:701-6. [PMID: 15184851 DOI: 10.1016/j.tripleo.2003.12.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The management of arteriovenous (AVM) malformations of the jaws is complex and requires an integrated team approach. Subspecialists, such as maxillofacial surgeons, interventional radiologists, and critical care intensivists, are commonly involved in the management of these patients. The current treatment options for maxillofacial AVMs are surgical resection combined with endovascular embolization. Surgical treatment of arteriovenous malformations has been associated with significant morbidity and mortality due to potential for massive blood loss. In the pediatric population extensive resection of the craniofacial skeleton may be associated with growth disturbance, functional compromise, and cosmetic deformity. We report a novel technique using endovascular embolization via direct transosseous puncture for a high-flow vascular malformation, obviating the need for extensive surgical resection, and review the important clinical aspects of these life-threatening lesions.
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Affiliation(s)
- Deepak Kademani
- Oral and Maxillofacial Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.
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35
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Huang F, Kuo YL, Ko SF, Ng SH, Lui CC, Jeng SF. Percutaneous puncture and pre-operative cyanoacrylate obliteration of a traumatic false aneurysm of an angular artery branch. Br J Radiol 2003; 76:746-9. [PMID: 14512337 DOI: 10.1259/bjr/98542646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a case of traumatic false aneurysm developed in the right glabella in a 5-year-old boy 3 weeks after an innocuous fall. Ultrasound, CT and facial arteriography did not reveal the feeding artery. After direct puncture of the glabellar bulge and rapid aspiration of blood, percutaneous contrast agent infusion revealed that the false aneurysm was supplied by the contralateral angular artery. Intralesional obliteration with cyanoacrylate was subsequently performed smoothly. Succeeding excision was easy and the cosmetic outcome was excellent.
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Affiliation(s)
- F Huang
- Departments of Plastic Surgery and Radiology, Chang Gung University, Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan
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