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Maxillomandibular Vascular Malformations: Report of Four Cases
Maxillomandibular 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.
Keywordsarteriovenous malformations - maxillomandibular AVMs - dental arcade AVMs - CT angiography - digital subtraction angiography - embolization
18 May 2021 (online)
© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Remonda L, Schroth G, Ozdoba C, Lövblad K, Lädrach K, Huber P. Facial intraosseous arteriovenous malformations: CT and MR features. J Comput Assist Tomogr 1995; 19 (02) 277-281
- 2 Sadove AM, Eppley BL, Gossweiler K, Hathaway R. Mandibular vascular malformations: treatment and long-term results. J Craniofac Surg 1994; 5 (05) 289-294
- 3 Kennedy KS. Arteriovenous malformation of the maxilla. Head Neck 1990; 12 (06) 512-515
- 4 Saraf R, Shrivastava M, Siddhartha W, Limaye U. Dental arcade arteriovenous fistulas: from diagnosis to treatment with emphasis on the role of endovascular or percutaneous treatment: single centre experience. J Craniomaxillofac Surg 2014; 42 (07) 1480-1485
- 5 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 (11) 2380-2387
- 6 Shapiro NL, Cunningham MJ, Bhattacharyya N, Choi IS, Pile-Spellman J, Joseph MP. Osseous craniofacial arteriovenous malformations in the pediatric population. Arch Otolaryngol Head Neck Surg 1997; 123 (01) 101-105
- 7 Churojana A, Khumtong R, Songsaeng D, Chongkolwatana C, Suthipongchai S. Life-threatening arteriovenous malformation of the maxillomandibular region and treatment outcomes. Interv Neuroradiol 2012; 18 (01) 49-59
- 8 Persky MS, Yoo HJ, Berenstein A. Management of vascular malformations of the mandible and maxilla. Laryngoscope 2003; 113 (11) 1885-1892
- 9 Fan X, Qiu W, Zhang Z, Mao Q. Comparative study of clinical manifestation, plain-film radiography, and computed tomographic scan in arteriovenous malformations of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94 (04) 503-509
- 10 Rodesch G, Soupre V, Vazquez MP, Alvarez H, Lasjaunias P. Arteriovenous malformations of the dental arcades. The place of endovascular therapy: results in 12 cases are presented. J Craniomaxillofac Surg 1998; 26 (05) 306-313
- 11 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 (07) 749-752
- 12 Loureiro CC, Falchet PC, Gavranich Jr J, Lobo Leandro LF. Embolization as the treatment for a life-threatening mandibular arteriovenous malformation. J Craniofac Surg 2010; 21 (02) 380-382
- 13 Liu DG, Ma XC, Zhao FY, Zhang JG. A preliminary study of angiographic classification and its correlation to treatment of central arteriovenous malformation in the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100 (04) 473-480
- 14 Choudhary S, MacKinnon CA, Morrissey GP, Tan ST. A case of giant nasal pyogenic granuloma gravidarum. J Craniofac Surg 2005; 16 (02) 319-321