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.
KEY WORDS
High flow arteriovenous malformation mandible - life-threatening intraoral bleeding
- primary free fibula reconstruction - temporary external carotid artery occlusion
