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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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Al-Sabbagh M, Hawasli A, Almehmadi N, Omami G, Miller CS. Hemorrhagic enlargement of the mandibular gingiva. J Am Dent Assoc 2023; 154:74-78. [PMID: 34836620 DOI: 10.1016/j.adaj.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 01/11/2023]
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3
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Ciccarese F, Chauvel-Picard J, Guibaud L, Viremouneix L, Perrot JL, Breton P, Gleizal A. Management of intra-osseous arteriovenous malformations of the mandible. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e544-e548. [PMID: 35272090 DOI: 10.1016/j.jormas.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Intra-mandibular arteriovenous malformations (IM-AVM) are rare congenital lesions sadly known by the appearance of cataclysmic haemorrhages. It represents a therapeutic challenge which requires a multidisciplinary approach. This paper aims to evaluate the characteristics and management of IM-AVM through the illustration of six case reports, the largest serie in the literature to our knowledge. This retrospective study included all patients with IM-AVM treated in the hospital of Lyon and Saint-Etienne between 1982 and 2021, in France. The management of mandibular AVMs should be individualized and permanently adjusted according to their stage of development, which makes their management difficult. Furthermore, long-term follow-up is essential to detect and manage the subclinical progression of the lesion. Based on these results and a systematic review of the literature, an algorithm has been developed to guide the treatment strategy for this are pathology.
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Affiliation(s)
- Fanny Ciccarese
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France; Jacques Lisfranc faculty of Medicine, Jean Monnet University, Saint-Etienne, France.
| | - Julie Chauvel-Picard
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France; Jacques Lisfranc faculty of Medicine, Jean Monnet University, Saint-Etienne, France; Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France
| | - Laurent Guibaud
- Department of Pedriatric and Fetal Imaging, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69500 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - Loïc Viremouneix
- Department of Pedriatric and Fetal Imaging, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69500 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - Jean-Luc Perrot
- Jacques Lisfranc faculty of Medicine, Jean Monnet University, Saint-Etienne, France; Department of dermatology, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France
| | - Pierre Breton
- Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - Arnaud Gleizal
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France; Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
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4
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Su L, Fan X, Yang X, Wang Z, Wen M, Wang D. Embolization for Arteriovenous Malformations in the Maxilla with Coils and Ethanol. J Oral Maxillofac Surg 2022; 80:1841-1851. [DOI: 10.1016/j.joms.2022.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
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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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Antúnez-Conde R, Navarro Cuéllar C, Salmerón Escobar JI, Díez-Montiel A, Navarro Cuéllar I, Dell’Aversana Orabona G, del Castillo Pardo de Vera JL, Navarro Vila C, Cebrián Carretero JL. Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature. J Clin Med 2021; 10:jcm10194565. [PMID: 34640581 PMCID: PMC8509390 DOI: 10.3390/jcm10194565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed and implemented in patients diagnosed with intraosseous venous malformation during 2006–2021, and a review of the scientific literature was also performed to clarify diagnostic terms. Eight patients were treated, differentiating two groups according to the technique: four patients were treated through standard surgery with resection and primary reconstruction of the defect with calvarial graft, and four patients underwent resection and primary reconstruction through virtual surgical planning (VSP), cutting guides, STL models developed with CAD-CAM technology and PSI (titanium or Polyether-ether-ketone). In the group treated with standard surgery, 75% of the patients developed sequelae or morbidity associated with this technique. The operation time ranged from 175 min to 210 min (average 188.7 min), the length of hospital ranged from 4 days to 6 days (average 4.75 days) and the postoperative CT scan showed a defect surface coverage of 79.75%. The aesthetic results were “excellent” in 25% of the patients, “good” in 50% and “poor” in 25%. In the VSP group, 25% presented sequelae associated with surgical treatment. The operation time ranged from 99 min to 143 min (average 121 min), the length of hospital stay ranged from 1 to 2 days (average of 1.75 days) and 75% of the patients reported “excellent” results. Postoperative CT scan showed 100% coverage of the defect surface in the VSP group. The multi-stage implementation of virtual surgical planning with cutting guides, STL models and patient-specific implants increases the reconstructive accuracy in the treatment of patients diagnosed with intraosseous venous malformation of the zygomatic bone, reducing sequelae, operation time and average hospital stay, providing a better cover of the defect, and improving the precision of the reconstruction and the aesthetic results compared to standard technique.
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Affiliation(s)
- Raúl Antúnez-Conde
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
- Correspondence:
| | - José Ignacio Salmerón Escobar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Alberto Díez-Montiel
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | | | | | - Carlos Navarro Vila
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - José Luis Cebrián Carretero
- Maxilofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.d.C.P.d.V.); (J.L.C.C.)
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Nagarajan K, Amuthabarathi M, Krishnan B, Sabarish S, Saravanan R. Maxillomandibular Vascular Malformations: Report of Four Cases. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractMaxillomandibular or dental arcade arteriovenous malformations (AVMs) are uncommon lesions with potential for life-threatening bleeding. We report three cases of vascular malformations and a case of pyogenic granuloma and propose a contrast-enhanced computed tomography (CT)-based workup of these lesions for definitive treatment. Four cases of orodental bleeding were diagnosed based on CT angiography (CTA) and treated using endovascular means. Three of them were subsequently operated and confirmed by histopathology. Two were low-flow AVMs, the third one a case of pyogenic granuloma, and one high-flow AVM. The first three lesions were embolized with polyvinyl alcohol particles and subsequently operated and the fourth high-flow one embolized using liquid embolic agent n-butyl cyanoacrylate (Glue). CTA can be used to show separate lesions of arterial vascularity and those of delayed/ venous enhancing lesions. Arterial phase-enhancing lesions are again subdivided in digital subtraction angiography into those of low-to-moderate vascularity and those with high flow, which are treated using particle embolization and liquid glue/onyx (± coil) embolization, respectively. The delayed venous phase enhancing lesions may mimic neoplasms and after tissue biopsy may be managed by sclerotherapy.
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Affiliation(s)
- Krishnan Nagarajan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Mohan Amuthabarathi
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Balasubramanian Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Sekar Sabarish
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Rajendiran Saravanan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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Sivolella S, Sibillin M, Lupi A, Zanette G, Giraudo C. Diode laser for the treatment of a high flow lip vascular malformation: a case report with four years follow up. Minerva Dent Oral Sci 2021; 71:248-253. [PMID: 33929135 DOI: 10.23736/s2724-6329.21.04486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND About 50% of vascular malformations are located at the head and neck region where they can usually be associated with functional and/or aesthetic limitations. Laser treatment has proven to be effective in treatment of small low-flow vascular malformations but little is known about the use of this therapy for high-flow larger arteriovenous malformations (AVMs). METHODS a congenital high-flow vascular malformation of the upper lip had to be treated because it was causing functional impairment and deformity which were affecting the quality of life. The mainstay of treatment is surgical therapy after embolization of the lesion but the treatment of high-flow lesions is difficult because of the high risk of mortality and morbidity. The lesion was then treated with transmucosal diode laser applications in multiple sessions. RESULTS The lesion progressively reduced in dimension without any sign of recurrence after multiple sessions of transmucosal diode laser applications. The clinical examination and the ultrasound scan performed four years after the last treatment demonstrated that no complications or further recurrence occurred. CONCLUSIONS multiple sessions of diode laser application can be a safe, effective and minimally invasive treatment for oral mucosa vascular malformations, even if characterized by high flow.
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Affiliation(s)
- Stefano Sivolella
- Dentistry Section, Department of Neurosciences, University of Padua, Padua, Italy
| | - Manuel Sibillin
- Dentistry Section, Department of Neurosciences, University of Padua, Padua, Italy -
| | - Amalia Lupi
- Radiology Institute, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Gastone Zanette
- Dentistry Section, Department of Neurosciences, University of Padua, Padua, Italy
| | - Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, University of Padua, Padua, Italy
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A rare case of a intraosseous arteriovenous malformation of the temporomandibular joint and mandible - Case report and literature review. Int J Surg Case Rep 2020; 76:394-398. [PMID: 33086167 PMCID: PMC7575646 DOI: 10.1016/j.ijscr.2020.10.011] [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: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/23/2022] Open
Abstract
Arteriovenous malformations (AVMs) are benign but locally invasive lesions. The mandible is a rare location of AVM, comprising less than 0.5–1% of all lesions. An AVM presentation within the temporomandibular joint is highly unusual. Reconstruction with titanium prostheses allows for excellent postoperative function.
Introduction This case report looks at a 47 year-old patient, presenting with a rapid onset mass of the left face. This report examines the case, the investigations undertaken, its management and undertakes a literature review of this uncommon condition and rare presentation. Presentation of case This patient had experienced functional deterioration, restriction and an evident swelling of the left face. Having identified the mass to arise from the mandibular condyle, an incisional biopsy was undertaken. The histology was suggestive of an arteriovenous malformation. Surgery was undertaken to excise the entire left mandibular condyle along with the lesion and then replace the temporomandibular joint with a custom made prosthesis. Discussion Arteriovenous malformations, or Haemiangiomas, can arise in any part of the body and can often grow over time. Although benign, lesions can be locally invasive and distort anatomy, resulting in functional issues. Their risk for hemorrhage and potentially significant blood losses is also a risk factor in their presence. Rarely arteriovenous malformations can occur in hard tissue, as in this case distorting and obliterating the temporomandibular joint. One’s only recourse is to remove and eliminate the lesion, however in cases such as this significant morbidity could ensue due to functional deficit. Hence consideration must be given to reconstruction. Conclusion Having excised the mass and reconstructed the temporomandibular joint with a titanium prosthesis, the patient experienced a good recovery with a return to normality.
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Li X, Su L, Wang D, Gui Z, Jiang M, Yang X, Han Y, Zhang L, Zheng L, Fan X. Clinical and imaging features of intraosseous arteriovenous malformations in jaws: a 15-year experience of single centre. Sci Rep 2020; 10:12046. [PMID: 32694548 PMCID: PMC7374740 DOI: 10.1038/s41598-020-68967-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 06/22/2020] [Indexed: 12/01/2022] Open
Abstract
Intraosseous arteriovenous malformations in jaws (j-AVMs) are rare congenital high-flow vascular anomalies with a high tendency of life-threatening haemorrhage and are regarded as one of the most dangerous haemorrhagic diseases in maxillofacial region. Pre-treatment clinical and imaging evaluations serve as the most important diagnostic modalities. A retrospective study involved 211 patients with j-AVMs from November 2003 to November 2017 was performed. The male-to-female ratio of j-AVMs was approximately 4:3. The mean age of the patients with j-AVMs is 21.86. Bleeding was the main complaint associated with j-AVMs. J-AVMs occurred in the mandible more often than in the maxilla (64.93% and 32.23%, respectively). Most j-AVMs (95.26%) occurred in the posterior teeth region. Classical imaging features of j-AVMs included: an unclear maxillary sinus with a mild ground-glass appearance (maxillary j-AVMs) and a clear oval or irregular lucency that is mostly centred on the root of the first molar (mandibular j-AVMs) on OPGs, enhancement in the cancellous bone on contrast-enhanced CTs. Other atypical features of j-AVMs were also concluded. A comprehensive diagnose system based on clinical and imaging features of j-AVMs could provide valuable reference data for clinical management of j-AVMs and help avoid improper iatrogenic trauma or delayed treatment.
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Affiliation(s)
- Xiao Li
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Lixin Su
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Deming Wang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Zhipeng Gui
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Xitao Yang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Yifeng Han
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Liming Zhang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Lianzhou Zheng
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China
| | - Xindong Fan
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai, 200011, Shanghai, People's Republic of China.
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11
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Nabeel AK, Jacob JE, Bose T, Sangeetha KP, Sandhya KN, Balan A. Great Radiologic Imitators: Arteriovenous Malformation of Mandible - A Case Series. Contemp Clin Dent 2018; 9:502-508. [PMID: 30166853 PMCID: PMC6104370 DOI: 10.4103/ccd.ccd_287_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An arteriovenous malformation (AVM) is a vascular malformation characterized by anomalous communications between arteries and veins without the normal intervening capillary bed. AVMs of jaw are extremely rare conditions that can give rise to dreadful complications if handled carelessly. Fifty percent of all intraosseous AVMs occur in the maxillofacial region and are extremely infrequent in the mandible. Only six cases of extraosseous submandibular AVMs have been mentioned in the literature. Three cases of AVMs involving the mandible, with a massive case involving both the mandible and submandibular region is reported. To the best of our knowledge, only one case is documented as a combined AVM involving both the mandible and submandibular region in literature.
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Affiliation(s)
- A K Nabeel
- Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - Jesmith Elsa Jacob
- Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - Tinky Bose
- Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - K P Sangeetha
- Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - K N Sandhya
- Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, Kerala, India
| | - Anita Balan
- Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, Kerala, 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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Chang L, Lv D, Jin Y, Yu W, Yang X, Ma G, Chen H, Lin X. High-frequency color Doppler ultrasound as the first diagnostic and monitoring choice for early superficial high-flow vascular malformations. J Med Ultrason (2001) 2017; 44:275-278. [PMID: 28224305 DOI: 10.1007/s10396-017-0771-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022]
Abstract
Diagnosis and monitoring of early high-flow vascular malformations could be a meaningful pursuit. However, there has been no ideal method for their long-term monitoring and prognosis. We examined 21 early high-flow vascular malformations in this study and deemed that high-frequency color Doppler ultrasound could be regarded as the first diagnostic and monitoring choice for early high-flow vascular malformations at present.
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Affiliation(s)
- Lei Chang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China
| | - Dongze Lv
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China
| | - Wenxin Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China
| | - Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China
| | - Gang Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Zhizaoju Road, Shanghai, 200011, China.
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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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Kim JE, Yi WJ, Heo MS, Lee SS, Choi SC, Huh KH. An unusual case of intraosseous vascular malformation of the maxilla mimicking fibrous dysplasia: a case report and literature review on imaging features of intraosseous vascular anomalies of the jaw. Dentomaxillofac Radiol 2014; 43:20130400. [PMID: 24940806 DOI: 10.1259/dmfr.20130400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intraosseous vascular malformation (IVM) is a relatively rare pathological condition that may pose significant risks, such as excessive bleeding, during surgical procedures. We present a case of an 18-year-old female patient with firm swelling in the left maxilla. A bony expansion over the left half of the maxilla with preservation of the outer cortex and a ground glass appearance on CT images initially revealed a possibility of fibrous dysplasia. However, a tentative diagnosis of IVM was made based on the vascular nature of the lesion as well as the patient's surgical history and additional imaging findings. IVM should be included in the differential diagnosis of an expansile bony lesion with trabecular alteration. Through the literature review, it was found that imaging findings, such as a neurovascular canal widening on CT images and a hyperintense signal on T1 weighted MR images, might be helpful in differentiating IVM from other pathologies.
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Affiliation(s)
- J-E Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Park ES, Jung YJ, Yun JH, Ahn JS, Lee DH. Intraosseous arteriovenous malformation of the sphenoid bone presenting with orbital symptoms mimicking cavernous sinus dural arteriovenous fistula: a case report. J Cerebrovasc Endovasc Neurosurg 2013; 15:251-4. [PMID: 24167809 PMCID: PMC3804667 DOI: 10.7461/jcen.2013.15.3.251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 07/30/2013] [Accepted: 08/16/2013] [Indexed: 01/19/2023] Open
Abstract
Intraosseous arteriovenous malformation (AVM) in the craniofacial region is rare. When it occurs, it is predominantly located in the mandible and maxilla. We encountered a 43-year-old woman with Klippel-Trenaunay syndrome affecting the right lower extremity who presented with a left orbital chemosis and proptosis mimicking the cavernous sinus dural arteriovenous fistula. Computed tomography angiography revealed an intraosseous AVM of the sphenoid bone. The patient's symptoms were completely relieved after embolization with Onyx. We report an extremely rare case of intraosseous AVM involving the sphenoid bone, associated with Klippel-Trenaunay syndrome.
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Affiliation(s)
- Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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18
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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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Louis RG, Yen CP, Mohila CA, Mandell JW, Sheehan J. A rare intraosseous arteriovenous malformation of the spine. J Neurosurg Spine 2011; 15:336-9. [PMID: 21663404 DOI: 10.3171/2011.5.spine10872] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a patient with an intraosseous spinal arteriovenous malformation (AVM) presenting as an epidural mass lesion that was causing spinal cord compression. The 59-year-old woman had bilateral numbness, weakness, and hyperreflexia of both legs. Magnetic resonance imaging revealed intermediate T1 signal and hyperintense T2 signal involving the right transverse process, bilateral pedicles, and T-5 spinous process; the lesion's epidural extension was causing severe canal compromise and cord displacement. Coil embolization was performed, and the patient underwent resection, after which preoperative symptoms improved. Histopathological analysis revealed a benign vascular proliferation consistent with an intraosseous spinal AVM. On review of the literature, the authors found this case to be the second intraosseous spinal AVM, and the first in a patient whose clinical presentation was consistent with that of a mass lesion of the bone.
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Affiliation(s)
- Robert G Louis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22903, USA.
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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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Collin AC, Viremouneix L, Guibaud L, Breton P. Les malformations artérioveineuses intra-osseuses. ACTA ACUST UNITED AC 2010; 111:11-8. [DOI: 10.1016/j.stomax.2009.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 08/17/2009] [Indexed: 10/19/2022]
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22
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Three-dimensional CT angiography for the diagnosis and assessment of arteriovenous malformations in the oral and maxillofacial region. J Craniomaxillofac Surg 2010; 38:32-7. [DOI: 10.1016/j.jcms.2009.10.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 10/15/2009] [Accepted: 10/21/2009] [Indexed: 11/22/2022] Open
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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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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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Redondo P. Malformaciones vasculares (II). Diagnóstico, histopatología y tratamiento. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70055-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Redondo P. Vascular malformations (II). Diagnosis, Pathology, and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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