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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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Dayo A, Omolehinwa TT. Mandibular Arteriovenous Malformation (Vascular Lesion) in a 16-Year-Old Patient. Dent Clin North Am 2023; 67:477-479. [PMID: 37244719 DOI: 10.1016/j.cden.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Intraosseous arteriovenous malformations in jaws are rare congenital vascular abnormalities that the dentist may encounter. A vascular lesion or disease should be suspected when there is unexplained bleeding from the oral cavity. Diagnostic imaging is a valuable tool in diagnosing and localizing vascular lesions. An understanding of some of the salient clinical and radiographic features of arteriovenous malformations in jaws aids the clinician in correctly diagnosing this condition and avoids iatrogenic injuries, such as hasty tooth extraction, which may potentially cause severe bleeding and possibly death. The dentist should acknowledge their expertise/limitation, and know when the need for referral arises.
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Affiliation(s)
- Adeyinka Dayo
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Temitope T Omolehinwa
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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3
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Shamloo N, Mashhadiabbas F, Safarpour R. Mandibular Arteriovenous Malformation with Unusual Radiographic Appearance. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2023; 24:66-70. [PMID: 36864993 PMCID: PMC9971608 DOI: 10.30476/dentjods.2021.90822.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/05/2021] [Accepted: 09/12/2021] [Indexed: 03/04/2023]
Abstract
Arteriovenous malformation of head and neck is a rare vascular anomaly but when present, it is persistent and progressive in nature. It can also represent a lethal benign disease due to massive hemorrhage. There are several indications for treatment including age, location, extension and type of vascular malformation. Endovascular therapy can effectively cure most lesions with limited tissue involvement. Surgery can be used in selected cases in combination with embolization. Here, we present a rare case of arteriovenous malformation of mandible with floating tooth appearance in an 11-year-old boy patient. Given the spectrum of imaging presentations seen and the crossover with other lesions, microscopic histopathological examination is the gold standard for diagnosis.
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Affiliation(s)
- Nafiseh Shamloo
- Dept. of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mashhadiabbas
- Dept. of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roohallah Safarpour
- Postgraduate Student, Dept. of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Enlargement of Inferior Alveolar Nerve Canal and Mental Neuropathy Associated with B-cell Lymphoma: A Case Report and Literature Review. J Oral Maxillofac Surg 2022; 80:1534-1543. [DOI: 10.1016/j.joms.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
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Resection and immediate reconstruction of two pediatric intraosseous capillary mandibular malformations. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01905-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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Interdisciplinary treatment algorithm for facial high-flow arteriovenous malformations, and review of the literature. J Craniomaxillofac Surg 2018; 46:765-772. [DOI: 10.1016/j.jcms.2018.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/13/2018] [Accepted: 03/02/2018] [Indexed: 01/22/2023] Open
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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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Zakharkina MV, Chechetkin AO, Krotenkova MV, Konovalov RN. Ultrasound diagnostics of a spontaneous arteriovenous fistula of the head and neck. J Ultrason 2017; 17:217-221. [PMID: 29075528 PMCID: PMC5647618 DOI: 10.15557/jou.2017.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/20/2017] [Accepted: 05/24/2017] [Indexed: 11/22/2022] Open
Abstract
An arteriovenous fistula is an abnormal connection between the arterial and venous systems. In the literature, there are well-described ultrasound findings of iatrogenic arteriovenous fistula as a potential complication from percutaneous transarterial or transvenous procedures. The most important sign is direct visualization of the fistula in the place of the access site. It is necessary to look for secondary signs of arterialization of the veins, which can suggest a diagnosis of an arteriovenous fistula. However, the accuracy and diagnostic quality of duplex scanning in the diagnostics of a congenital or spontaneous arteriovenous fistula of the head and neck area in adults have been poorly described in the literature. In this study, we discuss the opportunities of duplex scanning, based on two different cases of an arteriovenous fistula revealed by ultrasound and then confirmed by computer tomographic angiography.
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Hasnaoui N, Gérard E, Simon E, Guillet J. Massive bleeding after a tooth extraction: Diagnosis of unknown arteriovenous malformation of the mandible, a case report. Int J Surg Case Rep 2017; 38:128-130. [PMID: 28756362 PMCID: PMC5537400 DOI: 10.1016/j.ijscr.2017.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/07/2017] [Accepted: 07/15/2017] [Indexed: 11/29/2022] Open
Abstract
Mandibular arteriovenous malformation (AVM) are very unusual condition. They remain frequently undiagnosed until a severe bleeding occurs during an oral surgical procedure. This case was a real diagnostical challenge: clinical presentation and initial radiographic examination was atypical. Curently there is no guideline to manage this kind of pathology.
Introduction Arteriovenous malformations (AVMs) are very rare. Only 5% of them occurs in the jaws but they can manifest with dramatic bleeding and be life-threatening. Presentation of case We report the case of a 11-year-old healthy girl who presented a massive hemorrhage after extraction of the right mandibular first primary molar. This patient received a blood transfusion and was hospitalized in pediatric intensive care unit. CT angiography highlighted an AVM of the mandible. Treatment consisted in selective embolization. Discussion A review of the literature shows that the majority of AVMs of the jaws are often unknown until severe bleeding occurs during dental surgery. The low specificity of radiological signs on panoramic radiography makes the diagnosis particularly challenging. Their management requires an interdisciplinary approach. Selective embolization has a place of choice in the treatment of these complex pathologies. Conclusion Although AVMs of the jaws are rare, they are frequently revealed through a massive hemorrhage during tooth extraction. Dentists have to suspect them when young patients present some clinical features, as spontaneous gingival bleeding, unexplained dental mobility, or facial asymmetry.
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Affiliation(s)
- Nasr Hasnaoui
- Department of Oral Surgery, CHR Metz-Thionville, 1 Allée du Château, 57245 Ars-Laquenexy, France; Department of Odontology, CHRU Nancy, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France.
| | - Eric Gérard
- Department of Oral Surgery, CHR Metz-Thionville, 1 Allée du Château, 57245 Ars-Laquenexy, France.
| | - Etienne Simon
- Department of Plastic, Maxillofacial and Reconstructive Surgery, CHRU Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; Medicine Faculty of Nancy, 9 Avenue de la Forêt de Haye, 54505 Vandoeuvre-lès-Nancy, France.
| | - Julie Guillet
- Department of Odontology, CHRU Nancy, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France; Odontology Faculty of Nancy, 96 Avenue du Maréchal de Lattre de Tassigny, 54004 Nancy, France.
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Bhuyan SK, Birmiwal KG, Kar IB, Bhuyan R, Debta P. High Flow AV Malformation (A-V Shunt) of Mandible: A Rare Life Threatening Entity. J Clin Diagn Res 2017; 10:ZD16-ZD18. [PMID: 28050516 DOI: 10.7860/jcdr/2016/22221.8862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022]
Abstract
Intraosseous Arteriovenous Malformations (AVMs) in the head and neck region are very rare and potentially life threatening entities due to massive hemorrhage. These are the results of an embryonic abnormality of the vascular system. Depending on the blood flow and clinical presentations they are of different types like slow flow and high flow AVM. Here we present a case of high flow AVM involving mandible with a chief complain of gingival bleeding in a four year old girl child.
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Affiliation(s)
- Sanat Kumar Bhuyan
- Professor and Head, Department of Oral Medicine and Radiology, Institute of Dental Sciences, SOA University , Bhubaneswar, Odisha, India
| | - Krishna Gopal Birmiwal
- Senior Resident, Department of Oral Surgery, SCB Dental College , Cuttack, Odisha, India
| | - Indu Bhusan Kar
- Professor and Head, Department of Oral Surgery, SCB Dental College , Cuttack, Odisha, India
| | - Ruchi Bhuyan
- Professor, Department of Oral Pathology and Microbiology, Institute of Dental Sciences, SOA University , Bhubaneswar, Odisha, India
| | - Priyanka Debta
- Reader, Department of Oral Pathology and Microbiology, Institute of Dental Sciences, SOA University , Bhubaneswar, Odisha, India
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