Treatment of Head and Neck Arteriovenous Malformations Involving the Facial Nerve: A Tailored Algorithm

Head and neck arteriovenous malformations (AVMs) involving branches of the facial nerve often cause tremendous cosmetic, functional, and psychological problems that are challenging to treat. We proposed an algorithm to obtain the optimal treatment and esthetic outcome.

Medical records of 24 patients were reviewed between 2002 and 2015. The lesions were classified into 4 types: type 1, involving no more than 2 facial nerve branches, with a maximal diameter of lesion of 5 cm or less (n = 7); type 2, involving no less than 2 facial nerve branches, with a maximal diameter of lesion of greater than 5 cm (type 2a, facial nerve preservation, n = 8; type 2b, facial reanimation, n = 5); and type 3, involving the mastoid segments or the trunk of the facial nerve (n = 4). Treatment efficacy was assessed and facial function was evaluated using the regional House-Brackmann Facial Nerve Grading System.

Cure was achieved in 11 (45.8%) patients, and improvement was achieved in 12 (50.0%) patients, with a follow-up of 36.3 ± 32.9 months (range, 12-144 months). There was no significant difference of the regional House-Brackmann Facial Nerve Grading System score before and after treatment (type 1, unchanged; type 2a, P = 0.356; type 2b, P = 0.423; type 3, unchanged). Treatment outcomes were not significantly related to the type of nerve involvement (P = 1.000) and the facial reanimation procedure (P = 1.000).

Surgical excision or ethanol embolization alone is efficient for type 1 AVMs. The optimal approach for type 2a AVMs was surgery, followed by well-vascularized tissue transfer. In type 2b AVMs, the satisfied treatment results are achieved by lesion excision and immediate facial reanimation. A 2-stage strategy may result in contented treatment outcome in type 3 AVMs.