Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
August 2015
Next Case of the Month coming September 1 . . .
Mandibular Arteriovenous Malformation
- A high-flow subtype of head and neck vascular malformations
- Rare and potentially life-threatening1
- Often present with minor gingival bleeding, tooth loosening, lip numbness, malocclusion, and sometimes massive arterialized hemorrhage after dental procedures. Hemorrhagic shock following extraction of teeth.2
- Cross-sectional imaging can demonstrate findings ranging from small periapical lucencies to large, well-circumscribed erosive lesions. Bony overgrowth can occur.
- Postcontrast imaging demonstrates enhancement in areas of erosion similar to surrounding vessels
- Dynamic postcontrast MRA can diagnose arteriovenous shunting for treatment planning prior to embolization
- Color Doppler US may be used to document arterialized flow
- Multiple approaches to therapy have been used successfully, including transarterial, transvenous, or percutaneous embolization, and in some cases, resection with reconstruction of the mandible3–7
- Differential includes lytic mandibular tumors and slow-flow venous malformations. As a biopsy of this lesion would carry obvious significant hemorrhagic risk, careful attention to the density/intensity of contrast enhancement relative to nearby vessels, detection of nearby enlarged abnormal vessels, and performance of dynamic angiography to document A-V shunting are crucial for appropriate management.
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