title: Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis.
abstract: Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: anuramichelle@yahoo.com.
authors.forename: Anura Michelle
authors.initials: AM
authors.lastname: Manuel
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Santhi
authors.initials: S
authors.lastname: Kalimuthu
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sitra Siri
authors.initials: SS
authors.lastname: Pathmanathan
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Prepageran
authors.initials: P
authors.lastname: Narayanan
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Zurina
authors.initials: Z
authors.lastname: Zainal Abidin
authors.affiliation: Department of Radiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Khairul
authors.initials: K
authors.lastname: Azmi
authors.affiliation: Department of Plastic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Alizan
authors.initials: A
authors.lastname: Khalil
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017536:Carotid Artery, Common / Q000002:abnormalities* / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000002:abnormalities / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000379:methods*; D003131:Combined Modality Therapy; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D004621:Embolization, Therapeutic / Q000379:methods; D004844:Epistaxis / Q000175:diagnosis* / Q000209:etiology; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology; D005141:Eyelid Diseases / Q000175:diagnosis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D009915:Orbit / Q000098:blood supply; D017233:Orbit Evisceration / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation; D016896:Treatment Outcome
keywords: arteriovenous malformation; epistaxis; hemifacial