scholarly journals Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible

2018 ◽  
Vol 51 (02) ◽  
pp. 222-230
Author(s):  
Parvathi Ravula ◽  
Srikanth Rangachari ◽  
Rammurti Susarla ◽  
Laxman Sambari ◽  
Srinivas Saraswathi Jammula
Keyword(s):  
Arteriovenous Malformation ◽  
Curative Resection ◽  
High Flow ◽  
External Carotid ◽  
Primary Reconstruction ◽  
Free Fibula Flap ◽  
Definitive Therapy ◽  
Free Fibula ◽  
Life Threatening ◽  
Selective Embolisation

ABSTRACT Background: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subsequent reconstructions. With the advent of advanced multidisciplinary techniques aimed at definitive therapy, surgical resection and primary reconstruction can provide an ideal anatomical and functional cure. There are no previous reports on primary resection and reconstruction for life-threatening haemorrhage from high flow AVM of the mandible. Aim: We discuss our approach aimed at definitive therapy in life-threatening intraoral bleeding from large high flow AVM of the mandible. Subjects and Methods: Four patients were managed for life-threatening intraoral bleeding during 2015–2017. Compression was applied over the bleeding point before the airway could be secured by endotracheal tube. Under general anaesthesia, the external carotid artery (ECA) was temporarily occluded using an umbilical tape loop ligature to control the bleeding. Emergency selective embolisation was done, followed by curative resection and primary mandible reconstruction using free fibula flap. Outcome assessed. Results: Temporary occlusion of the ECA successfully controlled the bleeding immediately and facilitated selective embolisation and definitive therapy. All the four cases were successfully reconstructed with a good outcome. There was no recurrence during the follow-up period. Conclusion: In life-threatening intraoral bleeding from large high flow AVM of the mandible, emergency selective embolisation followed by curative resection and primary reconstruction is safe in achieving an ideal cure.

scholarly journals Management strategy for facial arteriovenous malformations

2008 ◽  
Vol 41 (02) ◽  
pp. 183-189
Author(s):  
S. P. Bhandari ◽  
L P. Sadhotra ◽  
P. Bhargava ◽  
A. S. Bath ◽  
M. K. Mukherjee ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Management Strategy ◽  
Complete Resection ◽  
High Flow ◽  
Rapid Progression ◽  
Correct Treatment ◽  
Cosmetic Results ◽  
Vascular Morphogenesis ◽  
Selective Embolisation

ABSTRACTArteriovenous malformations (AVMs) are uncommon errors of vascular morphogenesis; haemodynamically, they are high-flow lesions. Approximately 50% of AVMs are located in the craniofacial region. Subtotal excision or proximal ligation of the feeding vessel frequently results in rapid progression of the AVMs. Hence, the correct treatment consists of highly selective embolisation (super-selective) followed by complete resection 24-48 hours later. We treated 20 patients with facial arteriovenous malformation by using this method. Most of the lesions (80%) were located within the cheek and lip. There were no procedure related complications and cosmetic results were excellent.

scholarly journals Mandibular Arteriovenous Malformation in an 8-year-old Child: A Case Report

2016 ◽  
Vol 17 (1) ◽  
pp. 85-89
Author(s):  
BM Rudagi ◽  
Sudha Patil ◽  
Reshma Hammannavar ◽  
Tejus Jaiswal
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Vascular Anomaly ◽  
External Carotid Artery ◽  
External Carotid ◽  
Emergency Procedure ◽  
Dental Office ◽  
Life Threatening ◽  
Pediatric Dentists ◽  
Av Malformation

ABSTRACT Arteriovenous (AV) malformation is a congenital vascular anomaly in which there is an abnormal connection between the arterial and venous system resulting from developmental arrest during embryogenesis. In children, they are rare and potentially life-threatening. In the present case, an 8-year-old male patient presented with a simple gingival swelling associated with mobility of the corresponding teeth, which appeared relatively simple to excise but had an AV malformation associated with it. Timely diagnosis and investigations revealed its presence and hence prevented a catastrophy from occurring. Conventional method of surgical ligation of the external carotid artery was done as an emergency procedure and surgical resection was done without compromising the associated anatomic structures. This procedure helped control the bleeding as well as achieved an uneventful healing. This case report intends to create an awareness among Pediatric Dentists regarding the condition and thereby preventing an uncontrolled and unmanageable hemorrhage occurring in the Dental Office. How to cite this article Rudagi BM, Patil S, Hammannavar R, Jaiswal T. Mandibular Arteriovenous Malformation in an 8-year-old Child: A Case Report. J Contemp Dent Pract 2016;17(1):85-89.

scholarly journals Uterine arteriovenous malformation treated with selective embolisation of uterine arteries: a case report

2021 ◽  
Vol 28 (1) ◽  
pp. 17
Author(s):  
Vilius Rudaitis ◽  
Gailė Maldutytė
Keyword(s):  
Arteriovenous Malformation ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Pelvic Surgery ◽  
Uterine Arteries ◽  
Medical Termination Of Pregnancy ◽  
Medical Termination ◽  
Uterine Arteriovenous Malformation ◽  
Life Threatening ◽  
Selective Embolisation

Uterine arteriovenous malformation (AVM) is a very rare gynaecological condition, which can potentially lead to life-threatening abnormal uterine bleeding. In most cases uterine AVM is associated with prior pregnancy or pelvic surgery. We present the case of young woman seven weeks after medical termination of pregnancy diagnosed with heavy uterine bleeding due to uterine AVM, which was successfully treated with selective embolisation of uterine arteries.

Long-Term Follow-Up of Total Penile Reconstruction with the Sensate Osteocutaneous Free Fibula Flap

2006 ◽  
Vol 22 (03) ◽  
Author(s):  
Mustafa Şengezer ◽  
Serdar Ozturk ◽  
Mustafa Deveci ◽  
Mustafa Nisanci
Keyword(s):  
Free Fibula Flap ◽  
Fibula Flap ◽  
Long Term Follow Up ◽  
Free Fibula

Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

2021 ◽  
Author(s):  
Kuan-Ying Wang ◽  
Wen-Chung Liu ◽  
Chun-Feng Chen ◽  
Lee-Wei Chen ◽  
Hung-Chi Chen ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Muscle Flap ◽  
Flexor Hallucis Longus ◽  
Free Fibula Flap ◽  
Chi Square ◽  
Fibula Flap ◽  
Free Fibula ◽  
Chi Square Test

Abstract Background Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN. Methods This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998–2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared. Results Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, n = 13/70 vs. 46.7%, n = 7/15, p = 0.020, Chi-square test). Conclusion Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.

Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps

2020 ◽  
pp. 194338752098024
Author(s):  
Jorge Ernesto Cantini Ardila ◽  
Carlos Eduardo Torres Fuentes ◽  
Giovanni Montealegre Gomez ◽  
Susana Correa ◽  
Erika Paola Gutierrez ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Case Series ◽  
Mandibular Reconstruction ◽  
Free Fibula Flap ◽  
Occlusal Splints ◽  
Fibula Flap ◽  
Case Series Study ◽  
Free Fibula ◽  
Cutting Guides ◽  
Series Study

Study Design: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. Objective: To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. Methods: This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. Results: There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. Conclusion: Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique.

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