Sujijantarat Nanthiya, Padmanaban Varun, Larson Anna M, Troulis Maria J, Kaban Leonard B, Curtin Hugh D, Rabinov James D
Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
Department of Oral and Maxillofacial Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
Interv Neuroradiol. 2025 May 21:15910199251343000. doi: 10.1177/15910199251343000.
BackgroundFacial arteriovenous malformations (AVMs) can pose a risk of hemorrhage, bone erosion, and cosmetic deformity. Our objective is to evaluate treatment strategies and outcomes of patients with AVMs of the mandible and maxilla at our institution.MethodsA retrospective, consecutive series of patients with AVMs involving the mandible, maxilla and adjacent tissues was identified. Endovascular treatments included trans-arterial, trans-venous and/or direct venous access embolization. Staged procedures were performed until arteriovenous (AV) shunting was minimized or eliminated. Dental extraction was utilized in patients with residual AV shunting of an affected alveolar ridge with refractory bleeding and loose dentition. Follow-up angiography was evaluated.ResultsNine patients presented with AVMs of the mandible or maxilla to our institution in 1993-2023 (6 females; age range 7-38 years). Seven patients presented with a history of hemorrhage: two spontaneously and five at the time of biopsy or dental extraction. Embolization was performed in eight patients. Angiographic closure of the AVM was achieved in five patients. Six patients underwent surgery for debridement, resection or dental extraction. One lesion had complete spontaneous regression. No further bleeding episodes occurred in all patients. Seven patients had follow-up angiography (range 1-17 years) which showed significantly decreased or no residual AV shunting in all patients.ConclusionsMultidisciplinary treatment involving embolization and/or surgery can be accomplished safely and effectively for high-flow AVMs of the mandible and maxilla. Embolization with focused surgery may be a reasonable algorithm of clinical care and can result in significant reduction or durable closure of these lesions.
背景
面部动静脉畸形（AVM）可导致出血、骨质侵蚀和美容畸形风险。我们的目的是评估我院下颌骨和上颌骨AVM患者的治疗策略及结果。
方法
确定了一组涉及下颌骨、上颌骨及相邻组织的AVM患者的回顾性连续病例系列。血管内治疗包括经动脉、经静脉和/或直接静脉通路栓塞。进行分期手术，直至动静脉（AV）分流降至最低或消除。对于患侧牙槽嵴残留AV分流且出血难治和牙列松动的患者，采用拔牙治疗。评估随访血管造影结果。
结果
1993年至2023年，9例下颌骨或上颌骨AVM患者到我院就诊（6例女性；年龄范围7 - 38岁）。7例患者有出血史：2例自发出血，5例在活检或拔牙时出血。8例患者接受了栓塞治疗。5例患者实现了AVM的血管造影闭合。6例患者接受了清创、切除或拔牙手术。1例病变完全自发消退。所有患者均未再发生出血事件。7例患者接受了随访血管造影（范围1 - 17年），结果显示所有患者的AV分流均显著减少或无残留。
结论
对于下颌骨和上颌骨的高流量AVM，多学科治疗包括栓塞和/或手术可以安全有效地完成。聚焦手术的栓塞可能是一种合理的临床治疗方案，可显著减少或持久闭合这些病变。
