13 yr. old female diagnosed with an arteriovenous malformation of her lower left mandible following extraction of tooth #18.
Text of Arteriovenous malformation Lit Abstract
1. Mark Lit Abstract Oct 2010Arteriovenous malformation of the mandible: life-threatening complications during tooth extractionJD Engel, JS Supancic and LF Davis J Am Dent Assoc 1995;126;237-242 iNICAL PRACTICEOverview: 13 yr. old female diagnosed with an arteriovenous malformation of her lower left mandible followingextraction of tooth #18. hIntial ndingt13 year old female presented to her general dentist with occasional bleeding assoc withf ptooth #18. No obvious caries and tooth was mobile and slightly supraeruptedTPA #18 did not show any periapical pathosisq sFollowing extraction, immediate, severe, uncontrollable hemorrahage ensued - nger win the dike method of hemostasis was employed until an ambulance arrived 5 minsa wlater oEmergency Department tAn arteriogram was used to determine the source of bleedings pOperating Room - Initial Surgery - Mandible Sectioning Figure 1. Preoperative perlapical radiograph of the left mandibular molar region showing nondescripttradlolucent area.Vessels were embolized with special clotting coils placed in the internal maxillary artery, two in the lingual B tand 2 in the facial to decrease the ow by 80% a cThe AV malformation exended to the right premolar region and the mandible was sectioned from the leftscondyle to the right premolarwMandibular reconstruction plate with a metal condyle was contoured to t the defect. sThe sectioned mandible had teeth removed and cancellous portion removed then frozen for future i wreconstruction e vOperating Room - Second Surgery - Reconstruction aReconstruction after 6 months following sectioning- harvested cancellous bone from iliac crest bilaterally t bTMJ was reconstructed from the 5th right rib cFigure 2. Left hemimandible Immediately afterGraft was attached by screws to the cryopreserved mandibleresection. p1 year later, 5 x implants placed in mandible to support a removable prosthesisr ADiscussion:t!Diff Dx for Vascular anomolies: l MHemangiomas: vascular tumor that usually appears shortly after birth and grows rapidly until the v iage of 6-8 months. At that time, they slowly involute and regress by adolesence C[INICA[ rACJIC[g i aVascular malformation: lesions present at birth that may not become clinically evident until later inlife. Histologically: have a normal endothelial cell cycle and normal numbers of mast cellst s High ow - arterial and AV malformationsc Low ow - capillary, lymphatic and venous p m malformations Figure 3. Mandibular reconstruction bar withi condylar prosthesis next to the resected specimen.t Note that the teeth and cancellous marrow containing the tumor have been removed. rHow would I detect an arteriovenous malformation? 238 JADA, Vol. 126, February 1995Early signs/symptoms: Essentially a laundry list of bad thingsRadiographic: Typically normal appearanceHistory: The mother indicated that after extraction of herdaughters of primary teeth, she occasionally had blood on herpillow upon waking. Further investigation would have revealedthat the bleeding was more signicant than the dentist believed.The hemorrhage required the frequent changing of the entire bed Figurelinens by the mother. 7. raph of thep this radiograph ever, as there was no history of looked some- problems in this case, the what unusual,dentist was lulled into a falseTake Home:way to assess potential bleeding problems.of security. A panoramicPrevious extraction history is an excellenthe took a second radiograph, sense which was essentially the same. radiograph of the mandible may At that point, it was decidedhave been helpful in distin-possible intrabony that the tooth should be extract- guishing aSaini is a god ed because of the severe mobil-abnormality. However, as noted ity. In reviewing the bleeding previously, preoperative radio- history, the patient reportedgraphs often appear normal in