Comprehensive Treatment of Upper Lip Arteriovenous Malformation

Abstract

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.

Keywords: Arteriovenous malformations; Embolization; Reconstruction; Resection; Upper lip.

Fig. 1

An 18-year-old girl with a huge arteriovenous malformation (AVM) involving the upper lip. a Extraoral view. b Intraoral view

Fig. 2

Radiographic examination of the upper lip AVM before endovascular embolization showing feeding arteries from facial arteries. a Three-dimensional computerized tomography (3D-CT) reconstruction with vascular enhancement. b Digital subtraction angiograph (DSA)

Fig. 3

Post embolization angiographs showing significant vascularization decrease after endovascular embolization. a, b Right external carotid DSA. c, d Left external carotid DSA

Fig. 4

Intra-operative photographs. a Upper lip AVM and plan for Webster’s modification of Bernard–Burrow cheek advancement flap was outlined. b Upper lip defect after total resection of the AVM which involved more than two-thirds of the lip length. c Excision of two Burrow’s triangles from nasolabial region and mobilization of cheek flap. d Excision of another two Burrow’s triangles for reduction of upper lip height. e, f Inset of the flap by three layers suturing

Fig. 5

a, b 2 years follow up visit after surgery showing satisfactory esthetic and functional results