Arteriovenous fistula of the mandible: a case report

Abstract

Intraosseous arteriovenous malformations (AVM) are uncommon high-flow vascular malformation that can affect the maxilla or mandible. AVM may present with aspecific and misleading signs and symptoms. The diagnosis is often accidental and bleeding may represent the first symptom. Radiographically, there are few characteristic features and misdiagnosis is easy. Here we report the case of a young male affected by arteriovenous fistula on the right side of the mandible initially misdiagnosed as a cystic lesion. The patient underwent transarterial embolization of the vascular malformation and subsequently the lesion was surgically removed. 1-year follow-up showed complete healing of the mandibular bone and absence of recurrence. Intraosseous arteriovenous malformations are rare entities. However, due to their harmfulness, both clinicians and radiologists must be aware of this type of lesion and should always consider them in the differential diagnosis of osteolytic lesions.

Keywords: Arteriovenous; Dentigerous cyst; Embolization; Fistula; Oral and maxillofacial pathology; Vascular malformation.

Fig. 1

Panoramic radiography shows the lytic lesion in the right jaw

Fig. 2

CT scan shows the osteolytic lesion and the erosion of the dental elements. In this image, the ragged aspect of root resorption is particularly evident

Fig. 3

Selective angiography of the distal external carotid artery demonstrating the angioarchitecture of the arteriovenous fistula, arterial feeders, and the venous drainage into the right external jugular vein

Fig. 4

Embolization of the AVF with coils and the complete devascularization of the lesion

Fig. 5

The 1-year post-operatory panoramic radiographic

Fig. 6

One year after the intervention, the CT showed complete resolution of the AVM and complete ossification of the right body of the mandible

Fig. 7

One year after embolization and intervention, the magnetic resonance angiography showed complete resolution of the AVM