Shoukr, T., Abdel Khalek, H., Sadaka, M. (2023). Extensive Facial Arterio-Venous Malformations; Combined Approach, Embolization Followed by Surgical Reconstruction. The Egyptian Journal of Plastic and Reconstructive Surgery, 47(3), 165-171. doi: 10.21608/ejprs.2023.309691
Tarek Shoukr; Hazem Abdel Khalek; Mohamed Saad Sadaka. "Extensive Facial Arterio-Venous Malformations; Combined Approach, Embolization Followed by Surgical Reconstruction". The Egyptian Journal of Plastic and Reconstructive Surgery, 47, 3, 2023, 165-171. doi: 10.21608/ejprs.2023.309691
Shoukr, T., Abdel Khalek, H., Sadaka, M. (2023). 'Extensive Facial Arterio-Venous Malformations; Combined Approach, Embolization Followed by Surgical Reconstruction', The Egyptian Journal of Plastic and Reconstructive Surgery, 47(3), pp. 165-171. doi: 10.21608/ejprs.2023.309691
Shoukr, T., Abdel Khalek, H., Sadaka, M. Extensive Facial Arterio-Venous Malformations; Combined Approach, Embolization Followed by Surgical Reconstruction. The Egyptian Journal of Plastic and Reconstructive Surgery, 2023; 47(3): 165-171. doi: 10.21608/ejprs.2023.309691
Extensive Facial Arterio-Venous Malformations; Combined Approach, Embolization Followed by Surgical Reconstruction
1The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Tanta University
2The Department of Neuropsychiatry Faculty of Medicine, Tanta University
Abstract
Background: Arteriovenous malformations (AVMs) are composed of an abnormal communication between arterial and venous channels without intervening capillary bed. In the face, they commonly present with asymmetry, bleeding, tooth mobility and headache. The most successful treatment to date is embolization followed by surgical excision. Objectives: To evaluate the safety and efficacy of embolization followed by surgical reconstruction in the treatment of extensive facial AVMs. Patients and Methods: In this study we present the outcome of treatment of 25 patients presented with extensive facial AVMs and admitted in the department of plastic and reconstructive surgery at Tanta University Hospital in the period from January 2016 to July 2021. Our treatment strategy was embolization guided by digital subtraction angiography followed by surgical excision. Results: Twelve patients had one anatomic facial subunit affected by the lesion while nine cases had two subunits affected and four patients had 3 subunits affected. The average length of the widest dimension of the lesion was 6cm. Most of our cases (19 of 25) were in Schobinger stage 2 at the initial presentation. All our patients were followed for at least 1 year and none of them showed any evidence of recurrence of the lesion during the follow-up period. All our cases had controlled disease. Conclusion: Preoperative embolization followed by surgical excision is the ideal treatment for extensive AVMs of the face.
Mulliken J.B. and Glowacki J.: Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plastic and Reconstructive Surgery, 69 (3): 412-22, 1982. 2- AlShamekh S.: Arteriovenous Malformations. Dermatologic Clinics, 40 (4): 445-8, 2022. 3- Kansy K., Bodem J., Engel M., et al.: Interdisciplinary treatment algorithm for facial high-flow arteriovenous malformations, and review of the literature. Journal of 170 Vol. 47, No. 3 / Extensive Facial Arterio-Venous Malformations; Combined Approach cranio-maxillo-facial surgery: Official publication of the European Association for Cranio-Maxillo-Facial Surgery, 46 (5): 765-72, 2018. 4- Xun H., Li K., Li X., Liu Y., Du X. and Qin Z.: Direct percutaneous puncture digital-subtraction-angiographybased classification and treatment selection for soft-tissue arteriovenous malformations of maxillofacial region: A retrospective study. Int. J. Oral Maxillofac. Surg., 48 (2): 181-6, 2019. 5- Cuong T.C., Thang L.M., Giang N.L., et al.: Recurrent head and neck arteriovenous malformations: A case report. Radiology Case Reports, 18 (3): 766-70, 2023. 6- Krt A., Cemazar M., Lovric D., Sersa G., Jamsek C. and Groselj A.: Combining superselective catheterization and electrochemotherapy: A new technological approach to the treatment of high-flow head and neck vascular malformations. Frontiers in Oncology, 12: 1025270, 2022. 7- Wu J.K., Bisdorff A., Gelbert F., Enjolras O., Burrows P.E. and Mulliken J.B.: Auricular arteriovenous malformation: Evaluation, management, and outcome. Plastic and Reconstructive Surgery, 115 (4): 985-95, 2005. 8- Yee S.Y., Guo S. and Ho C.L.: Management of an Extensive Intraparotid and Auricular Arteriovenous Malformation. The American Journal of Case Reports, 23: e935337, 2022. 9- Watzinger F., Gössweiner S., Wagner A., Richling B., Millesi-Schobel G. and Hollmann K.: Extensive facial vascular malformations and haemangiomas: A review of the literature and case reports. Journal of Cranio- Maxillofacial Surgery, 25 (6): 335-43, 1997. 10- Tiwari R. and Singh V.K.: Arterio venous malformation of the face: Surgical treatment. J. Maxillofac. Oral Surg., 14 (Suppl 1): 25-31, 2015. 11- Cil B.E., Vargel I., Geyik S., Peynircioglu B. and Cavusoglu T.: Venous vascular malformations of the craniofacial region: Pre-operative embolisation with direct percutaneous puncture and N-butyl cyanoacrylate. The British Journal of Radiology, 81 (972): 935-9, 2008. 12- Rossi U.G., Verrina G., Ieradi A.M., Rutigliani M. and Cariati M.: Facial Artery Arteriovenous Malformation Endovascular and Surgical Treatment: Liquid Embolic Device an Advantage for Both Technique. Acta. Neurol. Taiwan, 29 (2): 54-8, 2020. 13- Panda N.K., Reddy C.E.E., Sharma R.K., Bapuraj J.R. and Radotra B.D.: High flow vascular malformations: Review of literature and a case report. Indian J. Otolaryngol. Head Neck Surg., 54 (3): 225-8, 2002. 14- Kohout M.P., Hansen M., Pribaz J.J. and Mulliken J.B.: Arteriovenous malformations of the head and neck: natural history and management. Plastic and reconstructive surgery, 102 (3): 643-54, 1998. 15- Goldenberg D.C., Hiraki P.Y., Caldas J.G., Puglia P., Marques T.M. and Gemperli R.: Surgical treatment of extracranial arteriovenous malformations after multiple embolizations: outcomes in a series of 31 patients. Plastic and Reconstructive Surgery, 135 (2): 543-52, 2015. 16- Visser A., Fitz John T. and Tan S.T.: Surgical management of arteriovenous malformation. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 64 (3): 283-91, 2011. Egypt, J. Plast. Reconstr. Surg., July 2023 171 17- Pedreira R., Lopez J., Ostrander B.T., et al.: An Interdisciplinary Approach to Treatment of Adult Facial Arteriovenous Malformations: A Review of the Literature and A Single Institution's Experience With "Late" Surgical Resection and Aesthetic Reconstruction. J. Craniofac. Surg., 30 (6): 1635-9, 2019. 18- Seccia A., Salgarello M., Farallo E. and Falappa P.G.: Combined radiological and surgical treatment of arteriovenous malformations of the head and neck. Annals of Plastic Surgery, 43 (4): 359-66, 1999. 19- de Miguel R., López-Gutierrez J.C. and Boixeda P.: Arteriovenous malformations: A diagnostic and therapeutic challenge. Actas Dermo-sifiliograficas, 105 (4): 347-58, 2014.
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