Endovascular Intervention and Management of Pediatric Mandibular Arteriovenous Malformation: A Case Report

Philadelphia, PA

Arteriovenous malformation of the mandible are a rare and potentially life threatening entity. Exsanguination from these lesions is a well documented event. Management of these lesions is unfortunately unclear and unstandardized due to their rare occurrence. Their presentation is wide and varied ranging from complaints of a loose tooth to acute hemorrhage and shock. Currently a multidisciplinary approach that typically involves input from oral maxillofacial surgeons (OMFS), otolaryngologists, and endovascular neurointerventionalists is required to manage these lesions. Often these lesions require both endovascular intervention and surgical resection. Due to the lesions high rate of recurrence and proximity to vital structures, gross surgical resection of the lesion is required. Gross surgical resection brings its own challenges in the growing pediatric patient including considerable aesthetic deformity and growth disturbances. Therefore definitive treatment with endovascular techniques is a reasonable goal for therapeutic management. Embolization of the lesion nidus is often hard to achieve in these malformations due to their high flow state. Retaining these agents of embolization at the target feeder vessels is difficult for these lesions. The case presented here is an example of a pediatric mandibular arteriovenous malformation that was treated entirely with endovascular management.