Salvage treatment of hemorrhagic arteriovenous malformations in jaws.

OBJECTIVE

To present our clinical experience on embolotherapy of arteriovenous malformations (AVMs) in jaws with acute hemorrhage.

MATERIALS AND METHODS

Twelve patients with a history of hemorrhage were selected for this study. Continuous interdental sling suture, digital pressure on the extraction socket, and iodoform gauze packed into the socket and fixed with sutures to the adjacent gum were used for temporary hemostasis before embolization. Fiberoptic bronchoscopy was used in all cases to facilitate endotracheal intubation. Absolute ethanol combined with coils was used as method of embolization.

RESULTS

Eight patients presented with intermittent interdental gum bleeding or controlled hemostasis before embolization. Four patients presented with torrential hemorrhage around the tooth, controlled by continuous pressure on the tooth and bilateral gum for temporary hemostasis. All patients were successfully salvaged before embolization. Ten of 12 patients were cured, and 2 had partial remission. Follow-up ranged from 12 to 26 months (mean, 16.5 months) for all patients, and there was no recurrence of the lesions.

CONCLUSIONS

The treatment of hemorrhagic AVMs of the jaw requires a multidisciplinary team approach; such cases can be successfully salvaged and stably controlled by embolization with coils and absolute ethanol.