Author(s)
Nima Vahidi1
MD
Shravan Renapurkar2
DMD
Albina Islam1
BS
Denis Rivet3
MD
Gregory Vorona4
MD
Brian Strife5
MD
Rajanya Petersson1,6
MD
Affiliation(s)
1 Dept. of Otolaryngology – Head and Neck Surgery, Virginia Commonwealth University Health System, Richmond, VA2 Div. of Oral and Maxillofacial Surgery, Virginia Commonwealth University Health System, Richmond, VA3 Dept. of Neurosurgery, Virginia Commonwealth University Health System, Richmond, VA4 Div. of Pediatric Radiology, Children’s Hospital of Richmond at VCU, Richmond, VA5 Div. of Interventional Radiology, Virginia Commonwealth University Health System, Richmond, VA6 Dept. of Otolaryngology – Head and Neck Surgery, Children’s Hospital of Richmond at VCU, Richmond, VA;
Abstract:
Introduction:
Arteriovenous malformations (AVM) are characterized by anomalous communications between arteries and veins with the absence of a normal capillary bed. Head and neck AVMs are an uncommon clinical entity, and those isolated to the mandible are even rarer. The initial presentation of these lesions may involve tooth loss and intraoral hemorrhage. Here, we present the case of a large pediatric mandibular AVM treated at our institution with long-term follow up results.
Methods:
Case report and literature review.
Results:
A 9-year-old, otherwise healthy girl, initially presented to our emergency department with significant intraoral bleeding for two days. She had recently lost several left mandibular primary teeth and had loosening of permanent teeth. She had been scheduled for tooth extraction by her general dentist, but severe bleeding prior to this brought her in. On exam at presentation, the left mandibular alveolar ridge was widened, soft on palpation, and with visible pulsatility. A CT angiogram (CTA) was ordered, which showed a large vascular lesion of the left hemimandible, with feeding vessels off the left facial and internal maxillary arteries and bony erosion of the mandible. She underwent MRI/MRA for further characterization, confirming AVM. Collaboration between oral maxillofacial surgery, pediatric otolaryngology – head and neck surgery, interventional radiology, neurosurgery, and radiology was crucial to treatment planning, which involved angiography, coiling, embolization, and ultimately surgical resection. Her surgery was now nearly four years ago, and she has progressed very well, with her most recent CTA demonstrating progressive healing and remodeling of the hemimandible.
Conclusions:
The management of head and neck AVMs is often difficult, and this case highlights the importance of a multidisciplinary team approach and careful planning. A review of the current literature was found to be limited, and we hope to add our experience and long-term results to the body of literature.