下がく骨に発生した動静脈奇形

Abstract

Arteriovenous malformations of the jaws are considered to be rare lesions, A-14-year-old school boy was referred from a hospital for profuse bleeding after the extraction of the mandibular right first molar. Orthopantomography showed an irregular radiolucency extending from the mandibular right lateral incisor region to the right mandibular notch and dental film showed “soap bubble” appearance. In angiogram the main feeding vessels appeared to be the right facial artery, the right lingual artery, the right inferior alveolar artery, the right massteric artery and the right buccal artery. Expecially the right facial artery was as enlarged as the right external carotid artery. Embolization of the facial artery was performed to decrease the blood flow in the region of the mandibular lesion. The next day under nasoendtracheal general anesthesia, preparations were made for enucleation by the ligations of the right external carotid, right lingual and right facial arteries. The enucleation of the tumor was carried out by an intraoral approach. The beginning of the operation was followed by profuse bleeding. However, after the ligation of the right inferior alveolar artery, hemorrhage was controlled and the tumor was removed with relative ease. The postoperative course was entirely without complications. Anorthopantomography taken one year and seven months after the operation showed significant osseous regeneration in the area of the lesion. The pathological diagnosis was arteriovenous malformation.