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Auricular arteriovenous malformation: evaluation, management, and outcome
June K Wu1, Annouk Bisdorff, Françoise Gelbert
1Vascular Anomalies Center, Division of Plastic Surgery, and Department of Radiology, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Plastic and Reconstructive Surgery
|March 29, 2005
Summary
Arteriovenous malformations (AVMs) of the ear are treatable, with amputation and embolization offering effective control. Most patients report satisfaction with management, though hearing can be affected.
Area of Science:
- Vascular Surgery
- Otolaryngology
- Radiology
Background:
- External ear arteriovenous malformations (AVMs) are the second most frequent extracranial AVMs in the head and neck.
- Auricular AVMs present a unique clinical challenge due to their location and potential for significant morbidity.
Purpose of the Study:
- To review the natural history, progression, and treatment outcomes of auricular arteriovenous malformations (AVMs).
- To assess patient quality of life following various treatment modalities for auricular AVMs.
Main Methods:
- Retrospective review of 41 patients diagnosed with auricular AVM.
- Data collection included medical records, imaging, photographs, and patient-reported quality of life surveys.
- Analysis of treatment outcomes including embolization, ligation, and amputation.
Main Results:
- The median age at presentation was 26 years, with most patients in Schobinger stage II or III.
- Expansion occurred across all age groups, not limited to vascular territories.
- Surgical amputation provided effective control in 80% of cases, while embolization alone had variable results.
- 81% of treated patients reported satisfaction with their management, with hearing unaffected or diminished in most.
Conclusions:
- Periodic evaluation is recommended for early-stage auricular AVMs, with intervention for stage III.
- Preoperative embolization combined with amputation is an effective treatment for auricular and para-auricular AVMs.
- Embolization can serve as a palliative option for children or unready patients; extensive AVMs require tailored endovascular and surgical approaches.