Complication of intraoral procedures in patients with vascular tumors

INTRODUCTION: Intraosseous malformations are rarely reported in the maxillofacial area. Because of bone growing processes, it is still a challenge to find the appropriate way to treat this disorder. The gold standard treatment for arteriovenous malformation is an endovascular embolization, combined with surgery. METHODS: The case of a 14-year-old boy with arteriovenous malformation of the mandible was followed during a period of 8 years. RESULTS: Several embolizations and surgical interventions were required, culminating in bone reconstruction with a fibula graft to achieve normal mandibular form and function. There was no recurrence of the malformation during the follow-up period. CONCLUSIONS: To obtain stable results in the case of intraosseous arteriovenous malformations of the mandible, a combination of embolization and surgery is recommended. Superselective embolization is possible in an emergency case.     

口腔颌面部动静脉畸形手术治疗的改进及其疗效评价

自1986年以来。作者对23例口腔颔面部动静脉畸形的诊断和治疗进行了前瞻性研究．提出一套诊疗常规即：先行选择性颈外动脉造影术。辅助性动脉栓塞术。病炷根治性切除术；然后对病灶面积大、缺损较严重的创面行立即修复术。获得了令人满意的疗效．全部病例术中计算出血量；全部病人获得随访结果：最长6年10个月、平均4年3个月，复发率8．6％(2／23)；作者还就辅助性动脉栓塞术和传统的结扎术疗效进行了比较；结论是二者存在显著差异。前者明显优越。     

Use of the radial forearm artery for secondary embolization of an extensive life-threatening arteriovenous malformation of the mid-face and anterior skull base – A case report

BackgroundArteriovenous malformations (AVM) of the head and neck are rare conditions with the majority of primary sites in the mid-face. Progression can lead to massive life-threatening bleeding. Treatment of choice is the combination of embolization and surgical resection. Diagnosis and management of AVM has been facilitated in recent years by the progress in imaging techniques and various microsurgical and endovascular embolization procedures.MethodsThis report presents the interdisciplinary approach to a case of life-threatening AVM of the mid-face in a 30-year-old patient.ResultsAngiography with embolization followed by resection and plastic reconstruction was performed. Follow-up showed incomplete obliteration of the AVM and lead to additional embolizations via the anastomosed radial artery. Complete eradication of the AVM was not possible during the three year follow-up period.ConclusionIn extensive vascular malformations of the head and neck, complete surgical removal is often impossible and associated with high risk of complications and mortality. Endovascular embolization is limited by the location of the AVM and can potentially cause stroke, ischaemia, necrosis, bleeding, blindness and adverse haemodynamic changes.     

乙醇加明胶海绵经动脉栓塞治疗颌面部蔓状血管瘤

目的使用无水乙醇加明胶海绵颗粒经供养动脉栓塞治疗颌面部蔓状血管瘤。方法６例颌面部蔓状血管瘤病例行单纯栓塞治疗术，经颈外动脉造影后以纯酒精加明胶海绵颗粒穿刺供养动脉做永久性栓塞治疗。结果本组病例随访２～１３．５个月未见复发。结论乙醇加明胶海绵栓塞治疗颌面部蔓状血管瘤可取满意疗效。     

Comprehensive Treatment of Upper Lip Arteriovenous Malformation

Arteriovenous malformations are uncommon congenital disorders in vascular development. They frequently involve craniofacial structures and result in a morphogenic abnormality with ominous arteriovenous shunting. We present a huge AVM of the upper lip in an 18-year-old patient who was successfully treated by the combination method of presurgical endovascular embolization and complete resection of the lesion. Subsequent surgical defect in upper lip, which involved more than two-third of the lip length, was reconstructed via Webster’s modification of cheek advancement flap.     

颌面部先天性动静脉畸形的PVA栓塞治疗

目的 评价颌面部先天性动静脉畸形行聚乙烯醇泡沫微粒（PVA）永久性栓塞的治疗效果。方法 8例颌面部先天性动静脉畸形（男3例,女5例）进行了PVA永久性栓塞治疗。数字减影的颈动脉造影在PHILIPS V3000下完成,PVA颗粒（250－500μm）,栓塞用导管4F或3F。结果 5例患者仅行单次栓塞,3例患者行双次栓塞。栓塞后造影,异常血管团消失,均达到影像治愈;搏动、杂音栓塞后消失;4例肿胀得到改善。栓塞后1－6月,未发现有口腔内渗血或出血。栓塞后反应主要表现为肿胀、疼痛、发热,一般持续3－7d。结论 颌面部动静脉畸形的PVA栓塞治疗安全、有效,但远期效果还有待长期观察。     

Interdisziplinäres Konzept zur Diagnostik und Therapie gefäßreicher Fehlbildungen im Gesichts- und Halsbereich

Purpose. In patients with extended vascular anomalies in the head and neck, therapeutic decisions may pose a challenge to maxillofacial surgeons, dermatologists, and interventional radiologists. We analyzed the value of an interdisciplinary classification and treatment concept. Patients and methods. The classification distinguishes hemangiomas and vascular malformations. Whereas hemangiomas are endothelial proliferations, vascular malformations are considered to be developmental anomalies, which are further classified into high-flow or low-flow lesions and according to the vascular channels into capillary, venous, or lymphatic malformations. Since 2000 we have provided interdisciplinary consultation for patients with vascular anomalies. In patients with hemangiomas and venous malformations, the clinical diagnosis is confirmed by color-coded duplex sonography and magnetic resonance imaging; angiography is performed as part of the treatment planning for patients with arteriovenous malformations. Patients with hemangiomas are treated surgically by cryosurgery or laser surgery or conservatively according to lesion size and behavior. In patients with venous malformations, percutaneous sclerotherapy is combined with surgical reduction; patients with arteriovenous malformations undergo transarterial embolization prior to surgical excision of the nidus. Results. A total of 73 patients attended the interdisciplinary consultation. This group included 53 patients with facial hemangiomas, 7 with venous malformations, 2 with capillary malformations, 5 with lymphatic malformations, and 6 with high-flow arteriovenous malformations. Conclusions. The interdisciplinary protocol increases diagnostic accuracy and helps to establish individual treatment plans for patients with extended vascular anomalies.     

Extensive facial vascular malformations and haemangiomas: a review of the literature and case reports

We present 6 selected cases of extensive facial vascular anomalies extending to the skull base or actually involving it. These patients are compared with other cases in the literature. The spontaneous course of these vascular lesions is different and so variable treatment modalities are suggested depending on the age of the patient and the type of lesion. In young children, haemangiomas are common and spontaneous involution is characteristic. Conservative treatment in the sense of a wait-and-see approach is thereby favoured if these is no urgent indication such as involvement of essential structures, e.g. blockage of an orifice as demonstrated in one case or complications such as excessive bleeding.Vascular malformations most commonly appear in adults, there is no tendency to spontaneous involution and resection is usually necessary, especially in arteriovenous malformations. Nowadays, preoperative superselective embolization is recommended to minimize intraoperative blood loss. Superselective embolization is the treatment of choice in cases of a-v fistulae. Proximal ligation of the supplying arteries should be avoided because this may make embolization more difficult, and may be responsible for the common occurrence of rapid revascularization.     

Comprehensive treatment of arteriovenous malformations in the oral and maxillofacial region.

PURPOSE: Arteriovenous malformations (AVMs) in the oral and maxillofacial region are rare but potentially life-threatening vascular lesions. We report our experience in treating these lesions in the oral and maxillofacial region. PATIENTS AND METHODS: Superselective intra-arterial embolization (SIAE), sclerotherapy, bone wax packing of bone cavity and curettage, radiotherapy, and surgical resection were used alone or in combination in 28 patients with AVMs in the oral and maxillofacial region. Among them there are 13 cases involving the soft tissue, 11 cases involving bone, and 4 cases involving both the soft tissue and bone. RESULTS: Follow-up ranged from 3 to 60 months (median, 22 months) after comprehensive treatment. The rates of improvement and cure were 89.3% and 60.7%, respectively. Sclerotherapy in 6 cases of AVMs was ineffective. The rates of improvement and cure in AVMs involving soft tissue treated by surgical resection were 23.1% and 84.6%, respectively. The rates of cure for AVMs involving the jaws treated by SIAE, bone wax packing, curettage, and partial bone resection alone or in combination was 100%. CONCLUSION: Three cases of AVMs involving both soft tissue and bone treated with SIAE and radiotherapy as well as surgical resection were cured. SIAE was an adjunctive treatment for the AVMs of soft tissue and jaws and for controlling bleeding. Surgical resection was an important treatment modality for AVMs. Bone wax packing of bone cavity and curettage was a simple, safe, and effective method for the treatment of AVMs of the jaws. Radiotherapy and sclerotherapy may not be effective methods for AVMs involving the soft tissue.     

口腔颌面部脉管性疾病的综合序列治疗

脉管性疾病(vascular anomalies)包括血管瘤和脉管畸形2大类,是婴幼儿期最常见的良性肿瘤或发育畸形,文献报道,血管瘤在新生儿的发病率为1.1%～2.6%,1岁时的发病率高达10%。其中,35%～60%发生在头颈部。虽然脉管性疾病属于良性病损,但发生在颌面部的病变,不仅导致严重的容貌毁损,还可能因为阻塞呼吸、消化道而有碍发音、进食,甚至导致出血、窒息并危及生命。20世纪80年代以前,国内外对于脉管性疾病的分类、诊断比较混乱,以至于在治疗上因“治疗过度”而带来许多后遗症或“治疗不足”而贻误时机。上述现象目前已经得到改善:首先国际上于1992…     

口腔颌面部软组织动静脉畸形血管构筑初探与治疗分析

目的 分析口腔颌面部软组织动静脉畸形(Arteriovenous Malformation, AVM)的血管构筑特征,探讨其治疗方法.方法 对35 例口腔颌面部软组织AVM行血管造影检查及栓塞治疗,分析所有病变的供血动脉、回流静脉及畸形血管网的分布特征.20例单纯栓塞治疗,15例行栓塞与手术治疗,随访10个月～6年,分析其疗效.结果 从血管造影表现看,口腔颌面部软组织AVM可分为4型:弥散型(15例),病变由多个动脉支供血,畸形血管呈弥散的网状结构;密集型(11例),供养动脉及畸形血管网密集分布,呈团块状;混合型(6例),病变部分较弥散分布,部分呈密集的血管团状;伴动静脉瘘型(3例),病变内含较大的动静脉瘘结构.从疗效看,35例中20例疗效良好,随访期间未见复发;13例复发需进一步治疗;2例巨大病变则进行性发展.结论 颌面部软组织AVM的血管构筑可分为4型,血管构筑的分型有助于选择适当的治疗方法,提高疗效.     

Central arteriovenous malformations of the maxillofacial skeleton: case report

Central arteriovenous malformation of the maxillofacial skeleton, though rare, is a well-documented entity. Past treatments have usually included some form of surgical intervention. Surgical resection as an attempt to cure has been effective but costly, ie, in relationship to patient morbidity and hospital expenditures. A case of vascular malformation is presented in which selective angiography and embolization as a primary treatment were used rather than ablative surgery. The patient tolerated the procedures well, with complete resolution of bleeding.     

Surgical technique for the treatment of high-flow arteriovenous malformations of the mandible.

The high-flow intraosseous arteriovenous malformation is a problematic vascular lesion which may affect bone and the dentition. Variable clinical presentations of this anomaly have resulted in a gamut of treatment modalities being reported ranging from simple curettage, resection, radiotherapy, sclerosing injections, and various forms of embolization, to immediate replantation of the resected segments. Embolization techniques alone have not been universally successful and have often resulted in rapid development of collaterals from surrounding vessels. Definitive treatment has usually involved complete surgical resection (when feasible) either alone, or in combination with other modalities such as embolization. Jaw resection, however, is deforming and leaves a defect often requiring subsequent reconstruction of the hard and soft tissues and replacement of any teeth lost with the resected segment. We report a surgical technique to treat mandibular arteriovenous malformations, which permits ligation of the feeding vessels and provides access allowing for complete removal of the intraosseous lesion. At the same time it not only prevents facial deformity by preserving the mandibular bone and oral soft tissue, but also, and more importantly, may preserve the dentition as well.     

An overview of the management of pseudoaneurysm of the maxillary artery: a report of a case following mandibular subcondylar osteotomy.

BACKGROUND: Aneurysms, pseudoaneurysms, and arteriovenous malformations of the maxillary artery are rare. This is why this case report and current opinions regarding therapy are presented. PATIENT: A 41 year old woman presented in 1991 with recurrent pain and swelling in the right infra-auricular region of 3 years duration which was unresponsive to antibiotics. She had undergone subcondylar osteotomies elsewhere 5 years previously. Imaging revealed a rounded radiolucency of the upper posterior border of the right mandibular ramus with calcification posterior to the radiolucency. The lesion was surgically treated by packing, diathermy and ligation of the external carotid artery and has now resolved completely. Methods for the management of pseudoaneurysms, arteriovenous fistulae and haemorrhage from the maxillary artery include angiography both for initial diagnosis of pseudoaneurysm, arteriovenous malformation and haemorrhage and, if suitable their treatment with endovascular occlusants. The advantages and drawbacks of surgery versus endarterial occlusion are rehearsed. CONCLUSION: Although endovascular intervention has become the first line approach, particulate embolization is more commonly used as a pre-operative technique. Lesions like one described here can of course be managed by surgery alone if sophistizated facilities and skill were not available.     

口腔颌面部脉管畸形112例手术治疗效果评价

目的 评价口腔颌面部脉管畸形的手术治疗的临床疗效。方法 对2008年6月至2012年10月中国医科大学口腔医学院口腔颌面外科收治的112例口腔颌面部脉管畸形患者,均采用手术切除治疗,病变切除后直接拉拢缝合83例,邻近皮瓣转移修复19例,中厚皮片移植修复10例。随访观察术后效果。结果 术后病理进一步证实,静脉畸形67例、微静脉畸形8例、淋巴管畸形4例、淋巴-静脉畸形24例、动静脉畸形9例。术后1例患者发生皮片感染,化脓部分坏死,患区给予湿敷换药后创面二期愈合。随访6个月至5年,治愈105例,其余7例于术后3～10个月复发,其中1例淋巴-静脉畸形、4例动静脉畸形、2例静脉畸形。复发的静脉畸形患者,病变内注射平阳霉素后均治愈;其他复发患者均再次手术切除后治愈。结论 手术切除治疗口腔颌面部脉管畸形在外形和功能上均可获得满意疗效,而且安全。     

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目的：评价口腔颌面部脉管畸形的手术治疗的临床疗效。方法对2008年6月至2012年10月中国医科大学口腔医学院口腔颌面外科收治的112例口腔颌面部脉管畸形患者,均采用手术切除治疗,病变切除后直接拉拢缝合83例,邻近皮瓣转移修复19例,中厚皮片移植修复10例。随访观察术后效果。结果术后病理进一步证实,静脉畸形67例、微静脉畸形8例、淋巴管畸形4例、淋巴-静脉畸形24例、动静脉畸形9例。术后1例患者发生皮片感染,化脓部分坏死,患区给予湿敷换药后创面二期愈合。随访6个月至5年,治愈105例,其余7例于术后3～10个月复发,其中1例淋巴-静脉畸形、4例动静脉畸形、2例静脉畸形。复发的静脉畸形患者,病变内注射平阳霉素后均治愈;其他复发患者均再次手术切除后治愈。结论手术切除治疗口腔颌面部脉管畸形在外形和功能上均可获得满意疗效,而且安全。     

Reconstruction of the face after resection of arteriovenous malformations using anterolateral thigh perforator flap

Arteriovenous malformations are high flow lesions that remain a challenge in the field of plastic surgery, interventional radiology, and neurosurgery. This is especially true for large lesions requiring a comprehensive team approach. From March 2001 to August 2004, six patients with arteriovenous malformation having extensive involvement of the skin underwent selective embolization followed by resection and reconstruction with anterolateral thigh perforator flap. The age of patients ranged from 22 to 43 years (average, 29 years); four were male and two were female. The size of the defect ranged from 8 x 10 cm to 12 x 14 cm. During the follow-up period from 3 months to 41 months, two patients required ancillary procedures to improve their aesthetic appearances. All patients achieved acceptable contour, appearance, and sensation without any incidence of recurrences. The anterolateral thigh perforator flap provides a large, thin and sensible flap. The anatomy of the flap is relatively constant and reliable. Despite the extensive involvement of arteriovenous malformation of the face, with selective embolization, maximal resection, and coverage with a well-vascularized tissue, it can be safely removed and successfully reconstructed.     

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动静脉畸形(arteriovenous malformations,AVM)为高血流血管畸形,口腔颌面部软组织内及颌骨中均可发生。主要临床表现为病变区皮色改变、皮温增高伴搏动,听诊可闻及吹风样杂音;严重者可出现明显面部畸形,并可发生溃疡及出血。治疗方法主要为血管内栓塞或硬化及手术治疗。本文介绍了栓塞治疗的方法及注意事项,并根据软组织及颌骨AVM的血管构筑特点探讨了其治疗的要点与疗效。软组织AVM的治疗应首选血管内栓塞或硬化治疗,对于存在严重面部畸形的病例可结合手术治疗。对于颌骨AVM尤其是发生大出血的病例,栓塞后行颌骨刮治术疗效确切,可有效避免复发。     

Vascular lesions of the maxillofacial region: a case report and review of the literature

There is frequently lack of understanding and apprehension among dental practitioners treating patients with vascular lesions of the oral and maxillofacial region. Arteriovenous malformations are rare lesions which can easily be misdiagnosed yet produce the very dramatic clinical presentation of severe life threatening oral bleeding. Much of this apprehension likely stems from a lack of understanding of these anomalies, including lesion behavior/ characteristics, clinical work-up, and treatment paradigms. A comprehensive, in depth review of the full spectrum of vascular lesions of the maxillofacial complex is beyond the scope of this review. The purpose of this article is to provide a comprehensive review of the diagnosis, treatment, and risks associated with these complex vascular anomalies and provide a case report. In 1982, Mulliken and Glowacki published a landmark article proposing characterization of vascular defects based on biologic and pathologic differences. Their work differentiated between two major categories of vascular lesions: hemangiomas and vascular malformations. Different categories, names, and treatment options have been advocated over the years with multiple outcomes. They can occur in various areas throughout the body, with 60 percent being located in the head and neck. The true mechanism of pathogenesis of vascular anomalies is still unclear. Embolization and surgery is often combined for extended cases to improve their facial contour and oral function. We present the case of a 29-year-old female that is 36 weeks pregnant and presented to University Hospital after having significant bleeding from her oral cavity. She was found to have a gingival lesion associated with a radiolucency in the right posterior mandible. During her stay she had an episode of acute bleeding that required an emergent exploration, embolization, and resection secondary to an Arteriovenous Malformation associated with the Inferior Alveolar Artery. We will discuss the presentation, treatment provided, and outcome of this patient. We will also cover the diverse group of congenital vascular malformations, and their pathologic, clinical, and radiologic diagnosis and management.     

气管切开全麻下无水乙醇栓塞治疗咽喉部静脉畸形20例报道

目的 分析咽喉部静脉畸形的治疗方法和效果。方法 总结我院2011年3月—2015年6月收治的咽喉部静脉畸形患者20例,在气管切开下行咽喉部静脉畸形无水乙醇栓塞治疗。结果 15例患者经2次无水乙醇栓塞后咽喉部静脉畸形萎缩并治愈。5例患者合并Ⅱ、Ⅲ度呼吸道阻塞,颞面、下颌、舌体及口底弥漫性静脉畸形行无水乙醇栓塞后,气道阻塞症状治愈,颌面部青斑褪色,静脉畸形缩小并恢复颌面部正常形态;其中3例合并巨舌,行舌体静脉畸形切除成形术取得成功。咽喉部静脉畸形治愈后随访2年未见复发,治愈率50%,有效率100%。结论 咽喉部静脉畸形应早期治疗,气管切开下行无水乙醇栓塞治疗是治愈咽喉部静脉畸形的有效方法。