Arteriovenous Malformation of the Mandible: A Rare but Life-Threatening Disease
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Arteriovenous Malformation of the Mandible: A Rare but Life-Threatening Disease
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Baharudin Abdullah, Abdullah Pohchi, Abdul Rani Samsudin
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The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Arteriovenous Malformation of the Mandible: A Rare but Life-Threatening Disease
Year: 2007
Copyright (license): CC BY 4.0
Summary of article contents:
Introduction
Arteriovenous malformations (AVM) in the mandible are rare but can lead to life-threatening situations, especially when they present with severe bleeding. These lesions often reveal symptoms such as recurrent gingival hemorrhage, bony swelling, tooth mobility, and facial asymmetry. A significant risk arises during dental procedures, where exsanguinating hemorrhage may occur. The case reported involves a 15-year-old Malay girl who experienced severe and persistent bleeding from her mandible, prompting her referral to a hospital for management.
Life-Threatening Hemorrhage from AVM
The patient's medical history began at age seven, presenting with mild recurrent bleeding from her lower right premolar tooth. As time progressed, the episodes increased in frequency and severity, ultimately resulting in significant spontaneous bleeding without trauma at age fifteen. Upon examination, imaging studies confirmed the diagnosis of an AVM in the mandible, characterized by a "soap bubble" appearance. Selective embolization of the right lingual artery was performed, followed by a segmental mandibulectomy to remove the affected area of the mandible and reconstruction using a rib graft. The timely surgical intervention was critical in reducing the risk of life-threatening hemorrhage.
Conclusion
Managing a mandibular AVM, as illustrated in this case, is complex and necessitates a high index of suspicion, particularly in patients with unexplained gingival bleeding. The clinical presentation can vary, and given the potential for severe complications, early diagnosis and intervention are paramount. The successful outcome in this case underscores the importance of surgical resection as a definitive treatment for AVMs in the mandible, which was vital for this patient’s recovery and future health.
FAQ section (important questions/answers):
What is an arteriovenous malformation (AVM) in the mandible?
An AVM in the mandible is a rare condition characterized by abnormal connections between arteries and veins, potentially leading to bleeding, bone swelling, tooth mobility, or facial asymmetry. It may be life-threatening if not treated appropriately.
What symptoms might indicate the presence of a mandibular AVM?
Common symptoms include recurrent unexplained gingival hemorrhage, swelling of the mandible, tooth mobility, and facial asymmetry. Severe cases may result in exsanguinating hemorrhage, particularly following dental procedures.
How was the case of the 15-year-old girl managed?
The patient underwent selective embolization of the right lingual artery followed by segmental mandibulectomy. A rib graft was used to reconstruct the defect, and she was closely monitored in the intensive care unit postoperatively.
What imaging studies are useful for diagnosing AVM in the mandible?
An orthopantomogram (OPG) often reveals a 'soap bubble' appearance of the mandible. Additional imaging techniques, like CT scans, MRI, and magnetic resonance angiography (MRA), help confirm the diagnosis and assess the extent of the malformation.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Arteriovenous Malformation of the Mandible: A Rare but Life-Threatening Disease”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Bleeding:
Bleeding is a critical symptom in the presentation of arteriovenous malformations (AVMs) within the mandible. In this case, the patient experienced recurrent episodes of severe gingival bleeding, which escalated significantly over time. The spontaneous and torrential nature of the bleeding is a life-threatening complication that necessitates urgent medical intervention.
2) Swelling:
Swelling refers to the diffuse enlargement observed on the outer aspect of the right mandible during examination. This swelling is indicative of the abnormal vascular network associated with AVM. In the provided case report, swelling accompanied the bleeding symptoms, highlighting the physical manifestation of the condition and its impact on the patient's oral structure.
3) Life:
Life, in this context, underscores the life-threatening nature of the presented case involving a mandible AVM. The patient’s persistent and severe bleeding led to substantial health risks. The urgency of the medical interventions, including surgery, reflects the critical importance of preserving the patient's life amid serious complications from the AVM.
4) Incision:
Incision refers to the surgical cut made during the segmental mandibulectomy procedure performed on the patient. The choice of a median lower lip split and right submandibular incision was crucial for providing adequate access and visibility to the involved vascular structures and facilitating the successful removal of the AVM-affected mandible segment.
5) Surface:
Surface pertains to the lateral aspect of the mandible where the tumor mass was identified during surgery. The characteristics of the surface, including the involvement of the cortex, are significant for understanding the extent of the AVM and planning the necessary surgical intervention to remove the affected area, preventing further complications.
6) Summer:
Summer does not seem relevant in the provided context. However, it could imply a time of warmth and growth, perhaps contrasting with the challenges presented by the medical condition. In a broader medical context, seasons like summer might relate to various health issues, but in this specific case report, it holds no apparent significance.
7) Filling (Filled):
Filled is used to describe the amount of blood lost during each bleeding episode experienced by the patient. The term 'filled 1 to 2 cupfuls' indicates the severity of the situation, emphasizing the large volume of blood loss. This quantified measure is alarming and highlights the urgency to address the AVM immediately.
8) Silk:
Silk refers to the silk string used during surgery to secure the external carotid artery, which is crucial in managing potential intraoperative hemorrhage. This precautionary measure underscores the seriousness of the surgical procedure on the patient with an AVM, where controlling blood loss is vital for ensuring patient safety during surgery.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Arteriovenous Malformation of the Mandible: A Rare but Life-Threatening Disease’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Mri, Right side, Rehabilitation, Facial Asymmetry, Lower jaw, CT scan, Tooth mobility, Severe hemorrhage, Primary therapy, Magnetic resonance imaging, Intensive care unit, Recurrent episodes, Trigeminal Nerve, Computed tomography, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Temporomandibular joint, External carotid artery, Arteriovenous malformation, Cortical expansion, Dental extraction, Conservative measures, Intracranial involvement, Magnetic resonance angiography, Bone biopsy, Lingual artery, Root resorption, Radiographic appearance, Gingival hemorrhage, Mandible, Life threatening bleeding, Salvage treatment, Persistent bleeding, Visual axis, Gadolinium, Resection, Alternative diagnosis, Large lesion, Private dental clinic, Functional risk, Life saving.