Interventional treatment strategies for arteriovenous malformations of the mandible and maxilla: 30-year institutional case series.

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.