Mark Lit Abstract Oct 2010Arteriovenous malformation of the mandible: life-threatening complications during tooth extracti...
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Arteriovenous malformation Lit Abstract


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13 yr. old female diagnosed with an arteriovenous malformation of her lower left mandible following extraction of tooth #18.

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Arteriovenous malformation Lit Abstract

  1. 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 finding t 13 year old female presented to her general dentist with occasional bleeding assoc with f p tooth #18. No obvious caries and tooth was mobile and slightly supraerupted T PA #18 did not show any periapical pathosis q s Following extraction, immediate, severe, uncontrollable hemorrahage ensued - finger w in the dike method of hemostasis was employed until an ambulance arrived 5 mins a w later oEmergency Department t An arteriogram was used to determine the source of bleeding s pOperating Room - Initial Surgery - Mandible Sectioning Figure 1. Preoperative perlapical radiograph of the left mandibular molar region showing nondescript t radlolucent area. Vessels were embolized with special clotting coils placed in the internal maxillary artery, two in the lingual B t and 2 in the facial to decrease the flow by 80% a c The AV malformation exended to the right premolar region and the mandible was sectioned from the left s condyle to the right premolar w Mandibular reconstruction plate with a metal condyle was contoured to fit the defect. s The sectioned mandible had teeth removed and cancellous portion removed then frozen for future i w reconstruction e vOperating Room - Second Surgery - Reconstruction a Reconstruction after 6 months following sectioning- harvested cancellous bone from iliac crest bilaterally t b TMJ was reconstructed from the 5th right rib c Figure 2. Left hemimandible Immediately after Graft was attached by screws to the cryopreserved mandible resection. p 1 year later, 5 x implants placed in mandible to support a removable prosthesis r ADiscussion: t! Diff Dx for Vascular anomolies: l M Hemangiomas: vascular tumor that usually appears shortly after birth and grows rapidly until the v i age of 6-8 months. At that time, they slowly involute and regress by adolesence C[INICA[ rACJIC[ g i a Vascular malformation: lesions present at birth that may not become clinically evident until later in life. Histologically: have a normal endothelial cell cycle and normal numbers of mast cells t s High flow - arterial and AV malformations c Low flow - capillary, lymphatic and venous p m malformations Figure 3. Mandibular reconstruction bar with i 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 1995 Early signs/symptoms: Essentially a laundry list of bad things Radiographic: Typically normal appearance History: The mother indicated that after extraction of herdaughter’s of primary teeth, she occasionally had blood on herpillow upon waking. Further investigation would have revealedthat the bleeding was more significant 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 panoramic Previous 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 decided have 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 reported graphs often appear normal in