Arteriovenous malformation of the base of tongue: Case report and literature review

Abstract

Arteriovenous malformations of the head and neck pose a challenging therapeutic and reconstructive problem. In this report we describe a rare case of an arteriovenous malformation of the base of tongue. The patient, a young adult female, was treated with embolization followed by surgical resection using a lateral pharyngotomy approach. Reconstruction of the extensive base of tongue defect was accomplished using a radial forearm free flap. Currently, the patient is decannulated, articulates clearly, tolerates a normal diet, and is without recurrence. Our treatment approach is discussed in detail and compared with alternative techniques.© 1998 Wiley-Liss, Inc. MICROSURGERY 17:706-709 1996Arteriovenous malformation (AVM) of the external carotid artery is a vascular lesion rarely encountered in clinical practice. Histologically, an AVM consists of thick-walled, dysmorphic arteries with aberrant venous connections. Secondary changes within the veins include progressive reactive hypertrophy, intimal thickening, and sclerosis. AVMs of the external carotid artery typically present in late childhood or early adulthood. Symptoms can include throbbing pain, a ''buzzing'' sound in the ear, or pulsatile tinnitus, depending on the location of the lesion.2,3 On physical examination, an AVM appears as an erythematous blush of the skin or mucosa that is warm to the touch. Arteriovenous shunting is suggested by the presence of a bruit on auscultation or Doppler examination. Infection, trauma, or hormonal changes can cause rapid expansion and bleeding in a previously stable AVM.Magnetic resonance imaging (MRI) is the preferred radiologic study for displaying the involved tissue planes and the flow characteristics of this lesion. In addition, angiography with selective embolization is usually performed prior to surgical resection to decrease the vascularity of the lesion and to define precisely the feeder vessels. Embolization followed by complete surgical resection provides the best chance for long-term cure. Incomplete surgical excision of the anomalous vascular channels invariably leads to further collateralization, shunting, expansion, and ultimately clinical recurrence. 4 In the present report we describe a rare case of an AVM of the tongue base. The patient was treated with embolization followed by complete surgical resection. Reconstruction was accomplished using a radial forearm free flap. The short-and long-term advantages of our treatment approach for this rare problem are discussed. CASE REPORTA 34-year-old white female presented to her local emergency room with hematemesis and epigastric pain. She had been previously diagnosed with peptic ulcer disease, based on a single episode of hematemesis. On physical examination, the patient was pale and tachycardic. A complete blood count revealed a hemoglobin of 7.9. The patient was fluidresuscitated using packed red blood cells. Emergent upper endoscopy revealed no identifiable bleeding source. An otolaryngology consultation was obtained and on oropharyngeal examination, a large...

Arteriovenous Malformations of the Tongue: A Spectrum of Disease

“…Distinguishing tongue AVM from other masses including intramuscular hemangioma, hamartomas, or teratomas can be challenging 12 . MRI, MRA, and angiography are the preferred imaging modalities in diagnosis of tongue masses and AVM 4,8,9,11,13 . In this study, we illustrate focal tongue masses consistent with AVM that demonstrate hyperintensity, flow voids, vascular shunting, and dilated contributing arteries apparent on MRI scans and angiography.…”

“…Few case reports have described lingual AVM 3,4,10,11 . In this study, we have identified two clinical entities, focal lingual AVM and diffuse AVM with tongue involvement.…”

“…Few case reports have described lingual AVM. 3,4,10,11 In this study, we have identified two clinical entities, focal lingual AVM and diffuse AVM with tongue involvement. Their presentation, clinical course, prognosis, and therapeutic requirements were distinctly different.…”

Transposition of a lingual thyroid to the submandibular space using a modified technique

“…10 The risk of creating a pharyngocutaneous fistula can be decreased by reconstruction with well vascularised tissue harvested from outside the zone of tissue injury. Good visualisation can decrease the risk of cranial nerve injury and facilitate effective haemostasis.…”

Transoral robotic surgery for the excision of base of tongue vascular lesions

“…Conservative management with steroids, interferon, or propranolol may be attempted, but surgery is often needed. 1,2 Surgical approaches traditionally involved open procedures [3][4][5] ; however, with the growth of transoral robotic surgery, 6,7 a new approach is available. This report describes how transoral robotic surgery can be used in a safe manner to resect base of tongue (BOT) vascular lesions with minimal morbidity.…”