Arteriovenous malformation of the mandible: life-threatening manifestation during tooth extraction

Abstract

We report on the case of a 31-year old female presenting a massive bleeding during extraction of left lower wisdom tooth, which could be managed by local compression. In the following transfemoral angiography an extensive arteriovenous malformation (avm) in the pterygomandibular space with osseous infiltration was diagnosed and embolised during the same session. After the acute stage the malformation could be controlled by repeated embolisation, the wound being closed by use of a transposition flap. Although arteriovenous malformations of the head and neck are rare, they can manifest with dramatic bleeding complications during surgical interventions. A thrill on palpation and auscultation may also refer to the existence of such a vascular lesion. An av-malformation may be stimulated by hormonal changes during puberty or pregnancy as well as by local trauma. Colour coded duplex sonography, magnetic resonance imaging and transfemoral angiography are suitable diagnostic tools. The treatment of choice is superselective embolisation followed by surgical resection of the vascular nidus, which should be performed by under an interdisciplinary approach.