Intraosseous embolotherapy of central arteriovenous malformations in the jaw: long-term experience with 8 cases.

PURPOSE: To investigate the long-term effects of direct intraosseous histoacryl embolotherapy on central arteriovenous malformations (AVMs) of the jaw. MATERIALS AND METHODS: Eight patients with central AVMs of the jaw (3 in the maxilla and 5 in the mandible) were treated with direct intraosseous histoacryl injection. These AVMs exhibited cystic radiolucency, with (n = 5) or without (n = 3) honeycombed component. On angiography, all the AVMs exhibited a large intraosseous nidus with multiple suppliers and drainages. The intraosseous lesions were percutaneously punctured with an 18- to 20-gauge needle, and NBCA diluted 30% to 40% with iodized oil was injected during venous compression. RESULTS: Postembolic arteriograms showed that all the AVMs were completely or nearly completely devascularized after single or multiple injections at the initial treatment. The follow-up period ranged from 3 to 8 years. Two AVMs experienced postembolic curettage and were anatomically cured. Three AVMs were anatomically cured after 1 to 3 sessions of embolotherapy. The other 3 AVMs were clinically cured after 1 (n = 2) to 4 (n = 1) sessions of embolotherapy. There were no procedure-related severe complications. CONCLUSIONS: Direct intraosseous glue embolotherapy can be a simple and safe technique for endovascular management of central AVMs in the jaw and is particularly effective in an emergency. Complete reossification of the intraosseous nidus can be anticipated if a complete occlusion is obtained.

Reconstruction of a huge oral maxillofacial defect caused by necrotic fasciitis secondary to leukaemia.

SUMMARY: An 8-year-old boy who was diagnosed with 'acute non-lymphoblastic leukaemia (M2)', contracted secondary oral maxillofacial necrotic fasciitis. The wound was cleaned with 3% hypertonic saline, and then covered with iodoform gauze every day for about 3 weeks before and after necrotic tissue debridement. The local infection was controlled, and plenty of new healthy granular tissue had grown. The patient was left with a huge defect including the mouth floor, submental area, submandibular area and right cheek when the necrotic tissue was removed. Reconstruction of the defect was very difficult because of the patient's pre-existing leukaemia condition and severe inflammatory local condition. We successfully reconstructed the defect by using the new healthy granular tissue and a trapezius myocutaneous flap. During 9 years of follow up, in order to improve quality of life, the patient underwent scar modification surgery and orthodontic treatment, and facial appearance and oral functions were deemed satisfactory.

Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps.

The ability of near infrared spectroscopy (NIRS) to predict vascular compromise in vascular free flaps postoperatively has been assessed, and the extent of regional tissue oxygen saturation (rSO(2)) after fibular flap transplantation was investigated quantitatively. To validate the sensibility and precision of the technique, the following methods were used. (1) Forearm vessel obstructive tests were conducted in four healthy volunteers. (2) Measurement and analysis of bilateral rSO(2) at the mandibular body and ramus were performed in 40 healthy volunteers by NIRS in the morning and afternoon. (3) Measurement and analysis of rSO(2) in transplanted fibular flaps for 41 cases with mandibular reconstruction were performed by NIRS at postoperative days 1-6. The results were: NIRS had high sensibility and precision in monitoring rSO(2) of living tissues. No significant difference in the values of rSO(2) was found across different times or areas in the normal mandible. However, rSO(2) in the transplanted fibular flaps was reduced compared to the value on the control side. rSO(2) decreased gradually 4-12 hours postoperatively. After that period, rSO(2) increased gradually and approached the value of the control side at 20 h after the operation. It can be concluded that NIRS is a reliable noninvasive method for monitoring blood circulation in transplanted tissues, particularly for buried flaps.

[A preliminary study of angiographic classification and treatment of central arteriovenous malformations in jaws].

OBJECTIVE: To elaborate on the angiographic classification of central arteriovenous malformations (AVMs) in jaws, and to evaluate the correlation between this classification and treatment options. METHODS: X-ray films and angiograms of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of radiolucency, feeding arteries, nidus of the malformations and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation between this classification and treatment options. RESULTS: The angiographic pictures of 25 cases with central AVMs could be divided into five types: type I (n = 5) was with merely diffused micro-arteriovenous fistulas (AVFs); type II (n = 8) demonstrated a large venous pouch, all the feeding arteries drained into it; type III (n = 7) had a large venous pouch together with diffused micro-AVFs (I + II); type IV (n = 2) had multiple venous pouches; type V (n = 3) had multiple venous pouches and diffused micro-AVFs (I + IV). The angioarchitecture corresponded well to the radiographic appearance in all except one case. With respect to the treatment, type II, III, IV AVMs gained clinical cure in 100% of cases, whereas type I and type V AVMs obtained clinical cure only in 3 of 5 and 1 of 3 cases respectively. CONCLUSIONS: Central AVMs in jaws exhibited variant patterns of angioarchitecture, which could be divided into five types. Elaboration of this classification was helpful for decision-making on choosing appropriate therapy.

A preliminary study of angiographic classification and its correlation to treatment of central arteriovenous malformation in the jaw.

OBJECTIVE: To elaborate on the classification of central arteriovenous malformations (AVMs) in the jaw based on angioarchitecture and to evaluate the correlation of this classification with treatment options. STUDY DESIGN: X-ray films and digital subtraction angiograms (DSA) of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of bone resorption, feeding arteries, nidus of the malformations, and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation of this classification system with treatment options. RESULTS: The angiographic pictures of 25 cases with central AVMs could be divided into 5 types: Type I (n = 5) had diffused microarteriovenous fistulas (AVFs); type II (n = 8) had 1 large venous pouch with all the feeding arteries draining into it; type III (n = 7) had a large venous pouch as well as diffused microAVFs (I+II); type IV (n = 2) had multiple venous pouches; and type V (n = 3) had multiple venous pouches and diffused microAVFs (I + IV). The angioarchitecture corresponded well to the x-ray appearance in all cases except 1 (96%). With respect to the treatment outcomes, type II, III, and IV AVMs gained clinical cure in 100% of the cases, whereas type I and type V AVMs obtained clinical cure only in 60% and 33.3% of the cases, respectively. CONCLUSIONS: Central AVMs in the jaw contained variant patterns of angioarchitecture and could be divided into 5 types. This angiographic classification was helpful for decision making about appropriate therapy.