Giant Arteriovenous Malformation of the Neck

Abstract

Arteriovenous malformations (AVM) have a wide range of clinical presentations. Operative bleeding is one of the most hazardous complications in the surgical management of high-flow vascular malformations. In the cervical region, the presence of vital vascular structures, such as the carotid artery and jugular vein, may increase this risk. This is a case of massive arteriovenous malformation deforming the neck and the face aspect of this aged lady and growing for several years. A giant mass of the left neck occupied the carotid region and the subclavian region. The AVM was developed between the carotid arteries, jugular veins, and vertebral and subclavian vessels, with arterial and venous flux. The patient underwent surgery twice for the cure of that AVM. The first step was the ligation of the external carotid. Seven days later, the excision of the mass was done. In postoperative period the patient presented a peripheral facial paralysis which completely decreased within 10 days. The first ligation of the external carotid reduces significantly the blood flow into the AVM. It permitted secondarily the complete ablation of the AVM without major bleeding even though multiple ligations were done.

Cervical AVM- A Case Report

“…1 Traumatism is a frequent cause of arteriovenous malformations, but most of the time the AVMs are congenital. 2 Defects in TGF-beta signalling and a genetic two-hit hypothesis are the prevailing theories to the pathogenesis. Trauma, ischaemic event secondary to thrombosis, ectasia, hormonal changes, and puberty can induce proliferation of the AVM and trigger the growth of the lesion and manifestation of its troublesome symptoms.…”

Malformación arteriovenosa en cavidad oral: A propósito de un caso y revisión de la literatura

“…Existen casos en los que se ha realizado tratamiento quirúrgico en dos pasos, ligando la carótida externa en una primera cirugía, para así reducir el flujo sanguíneo, y poder, en un segundo tiempo, quitar la masa completamente disminuyendo el sangrado 1 . Ligar sólo la carótida externa no es efectivo ya que facilita la nutrición a través de vasos que son inaccesibles quirúrgicamente, y la necrosis de una parte de la tumoración hace más fácil el flujo de sangre dentro de los tejidos de alrededor a través de otros canales 2 .…”

“…Se clasifican en malformaciones de alto flujo (malformaciones arteriovenosas) y bajo flujo (capilares, venosas y linfáticas) 1 . Las malformaciones de alto flujo son debidas a una comunicación entre una arteria y una vena, lo que produce un aumento de presión con dilatación de la vena (arterialización) y de la arteria suplente, produciéndose una degeneración de la pared de ambos vasos.…”

Approach of Dental Treatment in Arteriovenous Vascular Malformations Affecting Oral Tissues: Case Report

“…But in this case, no complication has developed. 14 The external carotid ligation is a controversial technique, because of risk of recurrence. Therefore, the resection of the lesion should be as complete as possible because of this risk.…”

“…In our study, during follow up of 2 years, no new vascular lesion in the cheek and submandibular region was revealed. 14 Multiple treatment options must be evaluated to achieve the final result. 13 Surgical removal of the lesion may lead to impaired facial growth, resulting in an abnormal appearence and dental occlusion.…”