The Yakes Vascular Malformation Center, United States
Purpose: To determine optimal management strategies for the treatment of intraosseous mandibular AVM.
Material and Methods: 12 patients (9 females, 3 males), age 9 -14; mean age 10, underwent endovascular therapy to treat their mandibular AVMs. 9 patients had distinct intraosseous AVMs. 3 had additional multiple facial and intra-maxillary AVMs requiring treatment. Outside institutions recommended massive hemi-facial resections in these patients. 4 patients had prior PVA and gel foam embolization, 1 patient had a lip graft, 1 had prior mandible surgery, all that had failed.
Results: All 12 patients have demonstrated MR and angiographic cure of their AVMs. 1 patient’s therapy is not completed and is on-going. The patients mandibular AVMs cured, a third AVM in this patient in the infratemporal fossa is still undergoing treatment. The follow-up range is 11 months – 41 months, with a mean follow-up of 29 months. No complications were noted in treatment of mandibular AVMS. 1 patient required a minor gingival surgery after treatment of an additional intramaxillary AVM with inferior extension.
Conclusions: Endovascular approaches to manage mandibular AVM can be curative. The mandibular intraosseous variety is largely a fistula between artery and vein within the bone and the bulk are Yakes Type IIIa/IIIb AVMs. All respond and can be cured by endovascular ethanol therapy alone. Surgery was not required in any patient. Surprisingly no complications were encountered in this patient series. Long-term cures are noted in this patient series with endovascular approaches alone. No massive surgical resections in any patient, even in patients with multiple AVMs of the soft tissues, mandible and maxilla, was required to effect cure. In patients who suffered hemorrhages from floating teeth, bone formed and stabilized the teeth and no further hemorrhages occurred. Ethanol sclerotherapy proved curative in mandibular intraosseous AVMs in patients who had additional facial soft-tissue and intramaxillary AVMs that were cured as well at long-term follow-up.