Arterio-Venous Malformations of the Nose: Combined Approach for a Successful Strategy.
OBJECTIVE
The purpose of the present study is to evaluate the vascular malformations of the head and neck. They are uncommon lesions, but some areas have a significant potential for fatality, due to their massive bleeding. The vascular anatomy of the nose carries a high recurrence rate, due to the unique characteristic of the nose, especially if deep vascular connection is present.


METHODS
The present article describes 2 patients of nasal dorsum arteriovenous malformations, both using a combined procedure: preoperative selective embolization, en-bloc tumor resection, and reconstruction with a forehead flap. Two female patients with arterio-venous malformations of the nose were examined, subjected to excision procedure and forehead flap reconstruction. Current treatment requires surgical resection of the nose and in conjunction with adjunctive endovascular embolization; it reduces arterio-venous malformations recurrence.


RESULTS
The authors report an endovascular and surgical technique to treat nasal arterio-venous malformations, which permits a complete resection and a reconstruction with a forehead flap. There were no major complications such as recurrent ulceration, infection, postoperative bleeding, or flap failure. All the patients responded positively and satisfactory results were achieved in both female patients.


CONCLUSIONS
To reduce the recurrence of arterio-venous malformations, the multidisciplinary therapy is mandatory. Recent advances in microsurgery and interventional radiology have greatly improved prognosis for patients with arterio-venous malformations. Therefore, a preoperative selective embolization followed by surgical excision seems to be a good compromise for arterio-venous malformations therapy. The forehead flap, for its characteristics, represents the better choice for nasal reconstruction.
*Clinic Department of Plastic and Reconstructive Surgery, "S. Maria della Misericordia" Hospital, University of Udine, Udine†Pediatric Department, Area of Surgery, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Hospital, Trieste‡Department of Surgical, Reconstructive and Diagnostic Science, University of Milan, Milan, Italy.
Daria
D
Almesberger
Francesco
F
Manna
Gianni Franco
GF
Guarneri
Andrea
A
Marchesi
Pier Camillo
PC
Parodi
D001165:Arteriovenous Malformations / Q000601:surgery*; D005260:Female; D005546:Forehead / Q000601:surgery*; D006801:Humans; D009666:Nose / Q000098:blood supply / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery*