Imaging Sci Dent.  2011 Sep;41(3):123-128. 10.5624/isd.2011.41.3.123.

Interventional radiography in management of high-flow arteriovenous malformation of maxilla: report of a case

• Khambete N
• Risbud M
• Mehta N

• KMID: 1449957
• DOI: http://doi.org/10.5624/isd.2011.41.3.123

Abstract

Arteriovenous malformations are extremely rare conditions in that can result from abnormalities in the structure of blood vessels, which may be potentially fatal. A 30-year-old female patient visited our hospital with a complaint of swelling on the right maxillary posterior gingiva along with the large port-wine stain on right side of face. On clinical examination, the swelling was compressible and pulsatile. Radiographic examination revealed a lytic lesion of maxilla. Diagnostic angiography revealed a high-flow arteriovenous malformation of maxilla which was treated by selective transarterial embolization of maxillary artery using polyvinyl alcohol particles.

Keyword

Arteriovenous Malformations; Maxilla; Interventional Radiography; Angiography

MeSH Terms

Adult
Angiography
Arteriovenous Malformations
Blood Vessels
Female
Gingiva
Humans
Maxilla
Maxillary Artery
Polyvinyl Alcohol
Port-Wine Stain
Radiography, Interventional
Polyvinyl Alcohol

Figure

• 

  Fig. 1 A. Extraoral photograph shows port-wine stain and extraoral swelling. B. Intraoral photograph shows the extent of the lesion from buccal aspect. C. Intraoral photograph shows the palatal extent of lesion.

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  Fig. 2 Intraoral periapical radiographs show coarse bony trabeculae and enlarged marrow spaces. A. Right maxillary posterior portion. B. Right maxillary anterior portion. C: Panoramic radiograph shows an ill-defined irregular area of bone destruction in right maxillary anterior region.

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  Fig. 3 A. Pre-embolization angiogram shows the abnormal blush in central incisor region. B and C. Angiogram during embolization shows passage of polyvinyl alcohol particles. D. Post-embolization angiogram shows occlusion of feeder vessel.

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  Fig. 4 Post-operative intraoral photograph shows regression of palatal lesion after selective embolization.

Reference

1. Buckmiller LM, Richter GT, Suen JY. Diagnosis and management of hemangiomas and vascular malformations of the head and neck. Oral Dis. 2010. 16:405–418.

2. Hyodoh H, Hori M, Akiba H, Tamakawa M, Hyodoh K, Hareyama M. Peripheral vascular malformations: imaging, treatment approaches, and therapeutic issues. Radiographics. 2005. 25:Suppl 1. S159–S171.

3. Nekooei S, Hosseini M, Nazemi S, Talaei-Khoei M. Embolisation of arteriovenous malformation of the maxilla. Dentomaxillofac Radiol. 2006. 35:451–455.

4. Lei ZM, Huang XX, Sun ZJ, Zhang WF, Zhao YF. Surgery of lymphatic malformations in oral and cervicofacial regions in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007. 104:338–344.

5. Bai Y, Jia J, Huang XX, Alsharif MJ, Zhao JH, Zhao YF. Sclerotherapy of microcystic lymphatic malformations in oral and facial regions. J Oral Maxillofac Surg. 2009. 67:251–256.

6. Mohammadi H, Said-Al-Naief NA, Heffez LB. Arteriovenous malformation of the mandible: report of a case with a note on the differential diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997. 84:286–289.

7. Larsen PE, Peterson LJ. A systematic approach to management of high-flow vascular malformations of the mandible. J Oral Maxillofac Surg. 1993. 51:62–69.

8. Noreau N, Landry P, Morais D. Arteriovenous malformation of the mandible: review of literature and case history. J Can Dent Assoc. 2001. 67:646–651.

9. Caiazzo A, Mehra P, Papageorge MB. The use of preoperative percutaneous transcatheter vascular occlusive therapy in the management of Sturge-Weber syndrome: report of a case. J Oral Maxillofac Surg. 1998. 56:775–778.

10. Lai QG, Li GJ, Yuan KF, Xu X, Wang YZ, Li YL, et al. Transarterial embolization of a high-flow maxillary arteriovenous malformation fed by multiple arteries. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009. 108:e17–e21.

11. Donnelly LF, Adams DM, Bisset GS 3rd. Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol. 2000. 174:597–608.

12. Kademani D, Costello BJ, Ditty D, Quinn P. An alternative approach to maxillofacial arteriovenous malformations with transosseous direct puncture embolization. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004. 97:701–706.

13. Speer AL, Panossian A, Arkader A, Stanley P, Anselmo DM. Vascular surgery for arteriovenous malformations. eMedicine from WebMD. Updated Aug 9, 2010. Available at http://emedicine.medscape.com/article/459927-diagnosis.

14. Johnson LM, Cook H, Friedlander A. Central arteriovenous malformations of the maxillofacial skeleton: case report. J Oral Maxillofac Surg. 1991. 49:759–763.

15. Woods NK, Goaz PW. Differential diagnosis of oral lesions. 1991. 4th ed. St. Louis: CV Mosby Co;285.

16. Orbach S. Congenital arteriovenous malformations of the face. Report of a case. Oral Surg Oral Med Oral Pathol. 1976. 42:2–13.

17. Lalli AF, Peterson N, Bookstein JJ. Roentgen-guided infarctions of kidneys and lungs. A potential therapeutic technic. Radiology. 1969. 93:434–435.

18. Nagler RM, Braun J, Daitzchman M, Peled M, Laufer D. Selective embolization for head and neck vasculopathies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002. 93:127–131.

19. Anderson JH, Grisius RJ, McKean TW. Arteriovenous malformation of the mandible. Oral Surg Oral Med Oral Pathol. 1981. 52:118–125.

20. McKenna SJ, Roddy SC Jr. Delayed management of a mandibular vascular malformation. J Oral Maxillofac Surg. 1989. 47:517–522.