Arteriovenous malformation of the tongue/ dental courses

ARTERIOVENOUS MALFORMATION OF
THE TONGUE – A CASE REPORT
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

 A male Patient aged
27years reported to our
department with a chief
complaint of swelling
on the tongue since 12
years.
C
H
I
E
F
C
O
M
P
L
A
I
N
T

 The swelling was of pin head sized to start with and
gradually increased to attain the present size
 No h/0 surfaces changes associated symptoms
trauma
H
O
P
I

Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental courses

 PAST MEDICAL, SURGICAL & DENTAL
HISTORY
not contributing to chief complaint & history
 FAMILY HISTORY
no similar lesions among others.
 GENERAL PHYSICAL EXAMINATION
no similar lesions elsewhere.

EXTRA-ORAL EXAMINATION
RIGHT SIDE LEFT SIDE

 HARD TISSUE EXAMINATION
NAD
 SOFT TISSUE EXAMINATION
A solitary well defined purple
colored spherical swelling
anterior 2/3 of the tongue
involving dorsal ventral and
lateral surface measuring
1x1.5cm in size
No discharge or surfaces changes
INTRAORAL EXAMINATION

ON PALPATION:
 The swelling was soft
in consistency
 non-tender
 non-fluctuant
 compressible
 non-pulsatile
 no fluid thrill
 not fixed to the
underlying structures.

 CLINICAL DIAGNOSIS
VASCULAR MALFORMATION OF TONGUE
 DIFFERENTIAL DIAGNOSIS
 MUCOCELE
 LINGUAL VARIX
 LYMPHANGIOMA

 COMPLETE HEMOGRAM.
 COLOR DOPPLER ULTRASONOGRAPHY

COLOR DOPPLER ULTRASONOGRAPY
 A well defined multicystic
lesion of size
1.2x1.0cm .
 Both arterial and venous
flow noted within,
predominantly of arterial
type.
A dilated feeding artery
noted posterior to the
lesion.

COLOR DOPPLER ULTRASONOGRAPHY

 FINAL DIAGNOSIS
ARTERIOVENOUS MALFORMATION OF TONGUE

FOLLOW UP

DISCUSSION

CONTENTS
 INTRODUCTION
 DEFINITION
 SYNONYMS
 ETIOLOGY
 CLINICAL FEATURES OF AVMs
 INVESTIGATIONS
 TREATMENT MODALITIES
 CONCLUSION

INTRODUCTION
 DEFINITION: Arteriovenous malformations are
abnormal, tangled collections of dilated blood vessels
that result from congenitally malformed vascular
structures in which arterial afferents flow directly into
venous efferents without the usual resistance of an
intervening capillary bed. (Merck manual 15edn)
SYNONYMS
 ACRAL ARTERIOVENOUS TUMOR
 ARTERIOVENOUS ANEURYSM
 CIRSOID ANEURYSM
 RACEMOSE HEMANGIOMAwww.indiandentalacademy.com

ETIOLOGY
 Unknown etiology
 Endocrine and inflammatory stimuli may activate
 situated as deep or superficial mass
 Congenital AV fistula - common type.
(A.william Barrett,Paul M.Speight,OOOOE 2000;90;731-8)

CLINICAL FEATURES
SITE
Lower lip > Commisure > Tip of the tongue > Upper lip > Cheek submucosa >
Floor of the mouth > Lateral border of the tongue.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:731-8)
 SUPERFICIAL LESIONS
SIGNS
 Nevertheless troublesome.
 Raised , can enlarge , present for months to years.
SYMPTOMS
 Asymptomatic
 Solitary ,although multiple lesions can occur.
 No systemic complicationswww.indiandentalacademy.com

 DEEP LESIONS
 Produce serious systemic signs and symptoms
(extensive arteriovenous shunting and soft tissue hypertrophy),
 Diagnosis made in conjugation with clinical and
radiographic examination.
(A.William Barrett,Paul M.Speight,OOOOE 2000;90:731-8)

INVESTIGATIONS
 DOPPLER
ULTRASONOGRAPHY: - most widely used
- non-invasive
- vascularity of lesion can be assessed
 BIOPSY : - probability of profuse bleeding
(Hiroshi yoshida, Hiroshi yusa, El ueno, J Oral maxillofacial surgery 1995;53;369-374)

 MAGNETIC RESONANCE
IMAGING vascularity cannot be assessed
 COMPUTED TOMOGRAPHY vascularity cannot be assessed

ARTERIOGRAPHY: - Valuable in assessing delineating feeding vessels
assessing size & location
- Invasive nature can cause complications
- allergic reactions to contrast media
(Hiroshi yoshida, Hiroshi yusa, El ueno, J Oral maxillofacial surgery 1995;53;369-
374)

TREATMENT MODALITIES
 ASYMPTOMATIC
rarely indicated.
 SYMPTOMATIC
SCLEROTHERAPY followed by surgical resection.
Agents : sodium tetradecyl sulphate
ethanolamine,
ethenol (95-100%)
(J.Oral Maxillofacial Surgery 2005;63;1484-1488)

 LASER THERAPY
Tunable flashlamp pulsed-dye laser(585-nm wavelength)
is widely used
 SUPERSELECTIVE ARTERIAL OR RETROGRADE VENOUS
EMBOLISATION
preoperatively will not diminish the extent of the
resection,also minimize intraoperative bleeding.
 EMBOLIZATION
must be in the epicenter , carried out 24 to 72hours
before resection.
(J.Oral Maxillofacial Surgery 2005;63;1484-1488)

CONCLUSION
 AVM of the tongue: a very rare entity
 Hindrances with complex classifications of diagnosis
many treatment options
 Advanced imaging modalities like ultrasonography and
arteriography have made the task easy.

Arteriovenous malformation of the tongue/ dental courses

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