Clinical assessment and management of auricular arteriovenous malformation: retrospective study

Abstract

Background: Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases. Methods: Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation. Results: Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients. Conclusion: Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.

Surgical management of auricular arteriovenous malformations: A literature review

“…First, most of the lesion is surgically removed, and then postoperative embolization is performed on the residual lesion, which is difficult to resect or adjacent to important anatomical structures (e.g., facial nerve). Ethanol is the main embolic agent used for postoperative embolization 38,40 . This methodology and timing can not only eliminate the lesions but also reduce the use of agents to reduce the risk of complications.…”

“…5,6,13,33,34 In partial resection, an adjuvant method has been proposed where the residual lesion is treated with ethanol embolization. 36,38 Complete resection is an effective treatment for auricular AVMs to achieve mass elimination 7,39,40 Some scholars believed that resections can be limited to the cartilage level since the EAC is usually not involved, so auricle amputation or partial pinnectomy is used to remove the lesion. 7,8,27,32 This method can provide a positive longterm effect with a relatively minimal risk of recurrence, but the total or partial loss of the auricle may affect the patient's appearance and mental status.…”

“…5,8,42 Preoperative embolization has been used as a method to reduce intraoperative blood loss and induce lesion fibrosis, which may provide a favorable surgical field and lesion delimitation, thus making the operation easier and more accurate. 8,33,40,45,71 Due to the risk of the development of collaterals, resection is usually recommended within 1-2 days after embolization, but in some studies, resection has been delayed to 1 week. 4,8,42,45 Preoperative embolization also has risks.…”

“…Ethanol is the main embolic agent used for postoperative embolization. 38,40 This methodology and timing can not only eliminate the lesions but also reduce the use of agents to reduce the risk of complications.…”

Correction of pixie ear: infraauricular skin redraping method

“…Pixie ear has an attached, tapered, and lowset earlobe and can be congenital or acquired [1][2][3][4]. Acquired factors include trauma, rhytidectomy, and total reconstruction of ear, among which rhytidectomy results in excessive skin resection around the ear or insufficient suspension of the deep soft tissues [1,11]. Traditional methods for pixie ear have been described.…”