[Arteriovenous malformations in the jaws. The place of intravascular therapy. Apropos of 14 cases].
OBJECTIVE
To analyze arteriovenous malformations (AVMs) of maxillo-mandibular arcades seen in our department since 1977, and to determine adequate treatment.


METHODS
Fourteen AVMs were reviewed to determine their revelation, their semiology, the treatment applied and the results that could be obtained. All these lesions were true AV shunts involving bone with or without soft tissue extension.


RESULTS
Eight patients belonged to the pediatric population. Six lesions were maxillary and 8 mandibular. All lesions were revealed during or after puberty by local swelling, pain, mass effect or bruit. Hemorrhage was the most frequent (71%) symptom. Teeth instability was detected in all these patients and was origin of the bleeding. The lesions were suspected clinically and confirmed radiologically. Angiography analyzed properly the architecture of the lesion (4 arteriovenous fistulas). Embolization was the clinical treatment in all patients: particles helped to stabilize the acute situations but failed to offer stable results, necessitating complementary embolizations and/or surgery (hemimandibulectomy in 2 patients). The use of acrylic glue (Histoacryl), injected percutaneously (5 patients), or transarterially in the AVM (4 patients)) provided cure in 6 of these lesions (43%) and long term stabilization for all the other AVMs. Teeth extraction could be performed thereafter in good conditions. Antibiotics and anti-inflammatory treatment helped to stabilize the evolutive risk of these lesions.


CONCLUSIONS
Embolization is the therapy of choice in these lesions. Appropriate use of glue offers a high rate of cure and/or clinical stabilizations and avoids unneeded surgery.
Rodesch
G
G
Service de Neuroradiologie Vasculaire Diagnostique et Thérapeutique, Hôpital Bicêtre, Le Kremlin.
Soupre
V
V
Vazquez
M
M
Fain
J
J
Alvarez
H
H
Lasjaunias
P
P
D000293:Adolescent; D000328:Adult; D001164:Arteriovenous Fistula / Q000628:therapy; D001165:Arteriovenous Malformations / Q000628:therapy*; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007568:Jaw / Q000098:blood supply*; D007571:Jaw Diseases / Q000628:therapy; D008297:Male