International Journal of Oral and Maxillofacial Surgery
Clinical PaperClinical PathologyHigh-flow paediatric mandibular arteriovenous malformations: case reports and a review of current management
Section snippets
Case 1
An 11-year-old Polynesian male with neurofibromatosis type I, had a highly mobile left mandibular molar extracted at home by a family member. His local medical practitioner referred him to the emergency department (RCH) with prolonged haemorrhage 3 days later, due to an inability to control the bleeding with pressure packs.
On oral examination in the emergency department, torrential haemorrhage occurred spontaneously and haemoglobin was noted to be 63 g/l. The patient’s mouth was packed with gauze
Discussion
Paediatric intraosseous AVMs in the mandible are potentially life-threatening due to the risk of exsanguination and they are challenging to manage. The need to control profuse haemorrhage was the primary reason for referral to the hospital in each of these cases. However, patients may also present with headaches, toothaches, earaches, mobile teeth, gingival bleeding, facial asymmetry, and tissue expansion8. Intraosseous AVMs may also exist without symptoms, with lesions being detected
Patient consent
Written consent was obtained to publish the clinical photographs
Funding
None.
Ethical approval
Not required, as the patients in the case reports provided consent for use of the clinical material.
Competing interests
None.
Acknowledgements
The Department of Medical Imaging, Monash Medical Centre, Melbourne, and the Department of Medical Imaging, Royal Children’s Hospital Melbourne are acknowledged.
References (23)
- et al.
Vascular anomalies of the maxillofacial region
J Oral Maxillofac Surg
(1986) - et al.
Haemangiomas and vascular malformations of the maxillofacial region—a review
Br J Oral Maxillofac Surg
(2006) - et al.
Experiences in managing arteriovenous malformations of the head and neck
Br J Oral Maxillofac Surg
(2016) - et al.
A systematic approach to management of high-flow vascular malformations of the mandible
J Oral Maxillofac Surg
(1993) - et al.
Treatment of a high-flow arteriovenous malformation by direct puncture and coil embolization
J Oral Maxillofac Surg
(1994) - et al.
Three-dimensional CT angiography for the diagnosis and assessment of arteriovenous malformations in the oral and maxillofacial region
J Craniomaxillofac Surg
(2010) - et al.
An alternative approach to maxillofacial arteriovenous malformations with transosseous direct puncture embolization
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2004) Diagnosis and treatment of congenital arteriovenous fistulas of the head and neck
Am J Surg
(1973)- et al.
Intraosseous mandibular artero-venous malformations: case report
J Craniomaxillofac Surg
(2009) - et al.
Conservative treatment of arteriovenous malformations of the mandible
Int J Oral Maxillofac Surg
(2001)