Arteriovenous malformation of the mandible: a life-threatening situation

Abstract

Arteriovenous malformation (AVM) of the mandible is not only a rare entity, but also one that can be potentially life threatening due to massive haemorrhage. The authors describe three cases of children with AVM of the mandible.

Management of an arteriovenous fistula with two nidus between the inferior alveolar artery and the external jugular vein

“…Many case reports of intraosseous embolization (with coils6–8 or cyanoacrylate9, 10) have been published, but the circumstances were different from those in our case in that the AVF were intraosseous and discovered with the occurrence of intraoral bleeding, whereas our patient's AVF was in contact with the mandible and had progressively lysed it. Access to the intramedullar portion of the fistula by hulling with the gouge forceps caused considerable bone loss.…”

Management of an arteriovenous fistula with two nidus between the inferior alveolar artery and the external jugular vein

“…Many case reports of intraosseous embolization (with coils6–8 or cyanoacrylate9, 10) have been published, but the circumstances were different from those in our case in that the AVF were intraosseous and discovered with the occurrence of intraoral bleeding, whereas our patient's AVF was in contact with the mandible and had progressively lysed it. Access to the intramedullar portion of the fistula by hulling with the gouge forceps caused considerable bone loss.…”

Microvascular bone grafting: A new long-term solution for intraosseous arteriovenous malformations of the mandible in children

“…However, embolization is not a definitive alternative to surgical resection because the blood flow through other feeders can increase and a collateral blood supply can develop (Ozdemir et al, 2002). Surgical intervention implies a partial or complete resection of the mandible (Perugini et al, 2004;Sakkas et al, 2007) as seen in the presented case. Surgical treatment of AVMs has been associated with significant morbidity and mortality due to the risk of massive blood loss.…”

“…Surgical treatment such as simple curettage without pre-or perioperative embolization can be dangerous because it may result in life-threatening hemorrhage. The surgical gold standard includes partial or complete resection of the mandible followed by reconstructive surgery (Engel et al, 1995;Motamedi et al, 2000;Perugini et al, 2004;Sakkas et al, 2007). In the case presented, we had to find a compromise between the complete resection of the lesion and an esthetic outcome of the still-growing face.…”

“…The diagnosis of an intraosseous AVM within the mandible or maxilla is a rare clinical entity. Therefore, it should be suspected when the interdental space is widened, in the case of resorption of tooth roots, mobile teeth, soap-bubble radiolucency, discolored mucosa, permanent bleeding, or persistent oral infections (Resnick et al, 1992;Engel et al, 1995;Sakkas et al, 2007). As previously mentioned, AVMs are difficult to detect on radiographs (Tao et al, 2010) and often present with non-specific symptoms.…”

Common conditions associated with mandibular canal widening: A literature review

“…They are rare in the head and neck region; however, 5% of them are located in the mandible and 50% are intraosseous lesions 3. Swelling, mucosal discoloration at the site, tooth mobility and immediate massive bleeding after extraction of such teeth are common findings 2627. These lesions manifest as unilocular or multilocular cystic lesions with well- or ill-defined borders on radiographs.…”

Management of an arteriovenous fistula with two nidus between the inferior alveolar artery and the external jugular vein

“…Many case reports of intraosseous embolization (with coils6–8 or cyanoacrylate9, 10) have been published, but the circumstances were different from those in our case in that the AVF were intraosseous and discovered with the occurrence of intraoral bleeding, whereas our patient's AVF was in contact with the mandible and had progressively lysed it. Access to the intramedullar portion of the fistula by hulling with the gouge forceps caused considerable bone loss.…”

Microvascular bone grafting: A new long-term solution for intraosseous arteriovenous malformations of the mandible in children

“…However, embolization is not a definitive alternative to surgical resection because the blood flow through other feeders can increase and a collateral blood supply can develop (Ozdemir et al, 2002). Surgical intervention implies a partial or complete resection of the mandible (Perugini et al, 2004;Sakkas et al, 2007) as seen in the presented case. Surgical treatment of AVMs has been associated with significant morbidity and mortality due to the risk of massive blood loss.…”

“…Surgical treatment such as simple curettage without pre-or perioperative embolization can be dangerous because it may result in life-threatening hemorrhage. The surgical gold standard includes partial or complete resection of the mandible followed by reconstructive surgery (Engel et al, 1995;Motamedi et al, 2000;Perugini et al, 2004;Sakkas et al, 2007). In the case presented, we had to find a compromise between the complete resection of the lesion and an esthetic outcome of the still-growing face.…”

“…The diagnosis of an intraosseous AVM within the mandible or maxilla is a rare clinical entity. Therefore, it should be suspected when the interdental space is widened, in the case of resorption of tooth roots, mobile teeth, soap-bubble radiolucency, discolored mucosa, permanent bleeding, or persistent oral infections (Resnick et al, 1992;Engel et al, 1995;Sakkas et al, 2007). As previously mentioned, AVMs are difficult to detect on radiographs (Tao et al, 2010) and often present with non-specific symptoms.…”

Common conditions associated with mandibular canal widening: A literature review

“…They are rare in the head and neck region; however, 5% of them are located in the mandible and 50% are intraosseous lesions 3. Swelling, mucosal discoloration at the site, tooth mobility and immediate massive bleeding after extraction of such teeth are common findings 2627. These lesions manifest as unilocular or multilocular cystic lesions with well- or ill-defined borders on radiographs.…”

Management of an arteriovenous fistula with two nidus between the inferior alveolar artery and the external jugular vein

“…Many case reports of intraosseous embolization (with coils6–8 or cyanoacrylate9, 10) have been published, but the circumstances were different from those in our case in that the AVF were intraosseous and discovered with the occurrence of intraoral bleeding, whereas our patient's AVF was in contact with the mandible and had progressively lysed it. Access to the intramedullar portion of the fistula by hulling with the gouge forceps caused considerable bone loss.…”

Microvascular bone grafting: A new long-term solution for intraosseous arteriovenous malformations of the mandible in children

“…However, embolization is not a definitive alternative to surgical resection because the blood flow through other feeders can increase and a collateral blood supply can develop (Ozdemir et al, 2002). Surgical intervention implies a partial or complete resection of the mandible (Perugini et al, 2004;Sakkas et al, 2007) as seen in the presented case. Surgical treatment of AVMs has been associated with significant morbidity and mortality due to the risk of massive blood loss.…”

“…Surgical treatment such as simple curettage without pre-or perioperative embolization can be dangerous because it may result in life-threatening hemorrhage. The surgical gold standard includes partial or complete resection of the mandible followed by reconstructive surgery (Engel et al, 1995;Motamedi et al, 2000;Perugini et al, 2004;Sakkas et al, 2007). In the case presented, we had to find a compromise between the complete resection of the lesion and an esthetic outcome of the still-growing face.…”

“…The diagnosis of an intraosseous AVM within the mandible or maxilla is a rare clinical entity. Therefore, it should be suspected when the interdental space is widened, in the case of resorption of tooth roots, mobile teeth, soap-bubble radiolucency, discolored mucosa, permanent bleeding, or persistent oral infections (Resnick et al, 1992;Engel et al, 1995;Sakkas et al, 2007). As previously mentioned, AVMs are difficult to detect on radiographs (Tao et al, 2010) and often present with non-specific symptoms.…”

Common conditions associated with mandibular canal widening: A literature review

“…They are rare in the head and neck region; however, 5% of them are located in the mandible and 50% are intraosseous lesions 3. Swelling, mucosal discoloration at the site, tooth mobility and immediate massive bleeding after extraction of such teeth are common findings 2627. These lesions manifest as unilocular or multilocular cystic lesions with well- or ill-defined borders on radiographs.…”