Management of arteriovenous malformation of the ear: A protocol for resection and reconstruction

Abstract

Objective: Arteriovenous malformations (AVM) of the ear show unique features. Progressive growth or inadequate management of AVMs may lead to bleeding, infection, cartilage exposure, and ultimately loss of structure. Total ear amputation is an alternative; however, due to the structural complexity of the ear, reconstruction is technically challenging. This study presents a treatment algorithm based on a clinical series, with treatment options including resection and immediate and late reconstruction.Methods: Between 2004 and 2018, 12 patients with auricular AVMs were treated with AVM resection and ear reconstruction at our hospital. Among these 12 patients, seven were women, and patients' ages ranged between 4 and 34 years. Parameters considered before resection and reconstruction were compromised ear extension (partial, total, or extra-auricular involvement), thickness (cutaneous and cartilaginous), symptoms (bleeding, infection, ulceration, and/or cartilage exposure), and preoperative embolization. Total resection of AVMs was planned as the first step in all cases, followed by primary closure. AVM resection was categorized into a partial or total procedure, resulting in partial or total ear defects. Reconstruction was categorized as immediate or delayed.Results: Preoperative embolization was performed in 10 patients. AVMs were totally removed, resulting in seven total ear amputations. In six of these patients, total ear reconstruction was performed 6 months later, and all patients were recurrence-free. Only one patient did not undergo ear reconstruction. Regrowth was not observed in any reconstructed ear.Conclusion: Treatment of ear AVMs requires a planned approach to achieve favorable clinical outcomes and for concomitant safe and definitive reconstruction.

Arteriovenous Malformation in the Auricle in a 59-Year-Old Woman

“…Case Reports in Otolaryngology AVM is usually supplied by one or more of these main vessels [7]. With embolization, nidus and venous outflow are occluded [2].…”

“…Preoperative embolization was not recommended for partial involvement of the auricle without cartilaginous involvement. Consequently, immediate or delayed reconstruction might be necessary [7].…”

“…Extracranial AVM are most frequently identified in the head and neck region; the most common site is the cheek followed by the ear [5,6]. AVM in the ear should be managed carefully because the skin is thin in the ear, the cartilage could be involved, and progressive growth or inappropriate management could cause bleeding, infection, and cosmetic problems such as deformity [7]. I present a case of a 59-year-old woman with AVM in the auricle.…”

Rezidivierende Blutungen aus dem äußeren Ohr

“…Der Hauptunterschied zwischen diesen beiden Kategorien besteht darin, ob in der Histopathologie ein erhöhter Endothelzellumsatz vorliegt [5]. Schobinger entwickelte ein Staging-System, um die Entwicklung von AVM wie folgt zu beschreiben: AVM beginnen als ruhige erythematöse Läsion (Stadium I); die Läsion schreitet mit Pulsation und/oder Fremitus fort (Stadium II); als Nächstes entwickelt sie Ulzerationen und Blutungen (Stadium III); und schließlich verursacht sie eine klinische Dekompensation mit shuntinduzierter kardialer Überlastung (Stadium IV) [1,3]. In unserem Fall wurde die Läsion als Stadium III klassifiziert (Ausdehnung mit einer Verdunkelung, Läsionspulsation mit dystrophen Hautveränderungen).…”

Surgical management of auricular arteriovenous malformations: A literature review

“…There are difficulties in the treatment of auricular AVMs for many reasons, including: (1) the auricle has unique anatomical characteristics (a thin skin envelope covers ear cartilage) that is of great significance to facial aesthetics; (2) there is diversity in the form of clinical manifestations and AVMs are rare; (3) there is a relatively high possibility of AVM recurrence. Although many different techniques or protocols have been used, surgery is still a primary management technique for auricular AVMs 5,7,8 . Unfortunately, in the auricular AVMs care community, there are no unified surgical management guidelines.…”