The management of intraosseous arteriovenous malformations in the head and neck area

It is necessary that the treatment of arteriovenous malformations in general be undertaken by a team that consists of a radiologist who is experienced in angiography and embolization and a plastic surgeon. The latter should be well versed in angiographic techniques and should be able to comprehend the dynamics of these malformations. In this report, three patients with high-flow, high-shunt arteriovenous intraosseous malformations of the head are presented. Two of these presented as emergencies with almost uncontrollable bleeding and were initially treated with embolization and then mandibular resection and reconstruction within the first 48 hours. In one patient, a further reconstructive procedure using free vascularized tissue was carried out. A third patient with involvement of the maxilla, again presenting with bleeding, was treated with embolization and, because of the deformity that would be created by resection, was simply observed. However, this patient is to be reassessed in the future and may well come to maxillectomy. It is emphasized that the treatment of these patients requires careful assessment, embolization, and resection as indicated after discussion between radiologist and surgeon.