Super-selective Embolisation and Surgical Excision of the Facial Arteriovenous Malformation

Abstract

Vascular anomalies broadly include vascular tumours and malformations. Arteriovenous malformations (AVM), though rare in the oral and maxillofacial regions, can present with swelling, facial asymmetry, ulceration, and bleeding tendencies, which can be life-threatening. Thus, to minimise the associated life-threatening consequences, prompt and appropriate diagnosis of the lesion is necessitated. The management of the AVM is a therapeutic challenge for maxillofacial surgeons; however, technological advances in interventional radiology have gained a foothold. Super-selective embolisation of the feeder vessels with subsequent resection of the lesion is the most widely accepted approach for management. The present report describes a unique case of a facial AVM managed through a trans-oral approach without any post-operative sequelae.

Keywords: arterivenous malformation; face; intraoral approach; resection; superselective embolisation.

Figure 1. Initial clinical presentation of the patient with rapidly progressive swelling on the right cheek

Figure 2. 3D reconstruction of the CT angiography showing the abnormal branching from the right facial artery at the body of mandible

Figure 3. Trans-arterial catheter angiography for depicting the arterio-venous shunting of right facial artery and vein

Figure 4. Digital subtraction angiography images

(A) Frontal view and (B) lateral view

Figure 5. Digital subtraction angiography images

(A) Pre-embolization and (B) post-embolization

Figure 6. Intraoperative image (A) and excised specimen (B)

Figure 7. Follow-up image after six months with surgical site healed completely and no recurrence seen