Treatment of mandibular high-flow vascular malformations: report of 2 cases

Two cases of high-flow vascular malformations affecting the mandible are presented. Manifesting mainly in childhood, intraosseous arteriovenous malformations are extremely rare morphologic errors of vascular morphogenesis that can lead to life-threatening hemorrhage without appropriate treatment. A dentist referred an 8-year-old girl with radiolucency in the left mandible and supraocclusion of the mandibular left first molar. During biopsy, massive bleeding occurred. Computed tomographic scan with contrast medium showed a vascular malformation. Arterial embolization was performed followed by surgical resection. Autologous bone transplantation and resorbable osteosynthesis plates were used for reconstruction. The second patient, a 15-year-old girl, had intense bleeding from the periodontal space of a highly mobile right mandibular second molar. Intraoral clinical examination showed a painless pulsatile swelling in the right buccal vestibule. Computed tomographic angiogram displayed an extensive vascular malformation involving the right mandible. After successful selective embolization, surgical resection, and reconstruction with autologous bone, transplantation was performed. Preoperative embolization is a low-risk procedure in highly vascularized lesions. It is a recommended procedure to avoid the increased risk of an emergency operation, to minimize blood loss during surgery, and to better plan reconstructive surgery.