1 vascular anomalies
TRANSCRIPT
05/02/2023vascular lesions of head and neck , v.lakshm
i
1
VASCULAR LESIONS
Presented by Y Vijaya lakshmiOMFS
05/02/2023vascular lesions of head and neck , v.lakshmi
2INTRODUCTION
Before the 1980s, the terminology that was used to describe vascular anomalies was confusing and ambiguous.
terminology used in the past port wine stain strawberry haemangioma salmon patch conjure up visual approximation to the lesions but have no correlation with the biological
behavior or natural history of these lesions
05/02/2023vascular lesions of head and neck , v.lakshmi
3Mulliken and Glowacki (1982)
Based on the clinical,histochemical,cellular criteria to distinguish between the various vascular anomalies.
1. HAEMANGIOMAS 2. VASCULARMALFORMATIONS.3
05/02/2023vascular lesions of head and neck , v.lakshmi
4
Modification of the original classification to include Predomonant vessel type The depth of the lesion Characteristics of flowClinically useful correlates with pathological & Radiological data
05/02/2023vascular lesions of head and neck , v.lakshmi
5
HAEMANGIOMASSuperficial (capillary haemangiomaa)Deep (cavernous haemangiomaa)Compound (capillary cavernous haemangiomaa)
VASCULAR MALFORMATIONS
Simple lesions
Low-flow lesionsCapillary malformation (capillary haemangioma, port-wine stain)Venous malformation (cavernous haemangioma)Lymphatic malformation (lymphangioma, cystic hygroma)
High-flow lesionsArterial malformation
Combined lesionsArteriovenous malformationsLymphovenous malformationsOther combinations
05/02/2023vascular lesions of head and neck , v.lakshmi
6
05/02/2023vascular lesions of head and neck , v.lakshmi
7
INFANTILE CONGENITAL RICH NICH
05/02/2023vascular lesions of head and neck , v.lakshmi
8
Based on anatomical presentation : Type I – Mucosal/cutaneous Type II – Submucosal/subcutaneous
Surgical management of vascular lesions of the head and neck: a review of 115 casesInt. J. Oral Maxillofac. Surg. 2011; 40: 577–583
05/02/2023vascular lesions of head and neck , v.lakshmi
9
Type III – Glandular ( LVM/VM + SG Type IV – Intraosseous Type V – Deep visceral ( para pharyngeal , infratemporal)
05/02/2023vascular lesions of head and neck , v.lakshmi
10
Type I – Mucosal/cutaneous lesion Excision with overlying skin or mucosa Primary closure or regional flap
Type II – Submucosal or subcutaneous Surgical access to lesion with total excision and primary closure
Type III – Lesions involving glands ex-parotid/ 5 submandibular Surgical access to glandular lesions with excision along with the involved gland and primary closure (Fig. 4A–D)
Type IV – Skeletal – involving the facial skeleton ex-maxilla/mandible/zygoma
Excision of involved skeletal structure with reconstruction
Type V – Deep visceral ex-parapharyngeal/ infratemporal Mandibulotomy to access the lesion followed by total excision
Surgical management of vascular lesions of the head and neck: a review of 115 casesInt. J. Oral Maxillofac. Surg. 2011; 40: 577–583
05/02/2023vascular lesions of head and neck , v.lakshmi
11HEMANGIOMA vs MALFORMATIONS
INFANTILE HEMANGIOMA Benign tumor Endothelial cell over proliferation Not always present at birth Rapid growth phase as the child
Involution during childhood
VASCULAR MALFORMATION Congenital dysplastic vessel Normal endothelial cell function Always present at birth but not
evident Grow with child , possible rapid
growth phase No involution
05/02/2023vascular lesions of head and neck , v.lakshmi
12
During fetal life, capillary plexuses morphologically differentiate into arteries, veins, and lymph channels while unneeded vessels are destroyed through apoptosis
PATHOGENESIS
05/02/2023vascular lesions of head and neck , v.lakshmi
13IMMUNOHISTOCHEMISTRY MARKER
GLUT 1 VEGF CYCLIN EGFR
05/02/2023vascular lesions of head and neck , v.lakshmi
14EPIDERMOLOGY
CAUCESIANS LOW BIRTH WEIGHT FEMALE PRE MATURITY MULTIPLE GESTATIONS
05/02/2023vascular lesions of head and neck , v.lakshmi
15CLINICAL PRESENTATION
Present as blanching of skin Telengectiasis Appearance depend on depth of lesion Papillary dermis – violaceous / crimson red Reticular dermis – raised smooth lesion with bluish hue / normal color FIRM RUBBERY NON COMPRESSIBLE
05/02/2023vascular lesions of head and neck , v.lakshmi
16History and clinical examination
05/02/2023vascular lesions of head and neck , v.lakshmi
17Grey-scale ultrasound and Doppler analysis
defining whether the lesion is solid or cystic to establish the presence or absence of high flow vessels
05/02/2023vascular lesions of head and neck , v.lakshmi
18MAGNETIC RESONANCE IMAGING
extent of the lesion Better contrast between the lesion and surrounding tissues has multiplanar capabilities distinguish between the different types of vascular anomalies.
05/02/2023vascular lesions of head and neck , v.lakshmi
19Contrast-enhanced computed tomography
evaluating intraosseous lesions bony margins of extensive lesions that are under consideration for resection.
05/02/2023vascular lesions of head and neck , v.lakshmi
20Digital subtraction angiography (DSA)
mapping out the blood supply of the lesion assessment of the characteristics of flow of arteriovenous malformations therapeutic endovascular interventions
submandibular hi-flow AVM
05/02/2023vascular lesions of head and neck , v.lakshmi
21
the left mandibular AVM with feeder vessels from both the facial (A) and lingual (B) arteries.
05/02/2023vascular lesions of head and neck , v.lakshmi
22Haemangioma
Most common “ tumour” in white infants (10–12%) head and neck region – common (60%) solitary (80%) girls - boys (3:1) Multiple cutaneous lesions (three or more) are often associated with visceral involvement Facial haemangiomas have a predilection for segmental distribution and for regions of embryological fusion
Haemangiomas and vascular malformations of the maxillofacial region—A review British Journal of Oral and Maxillofacial Surgery 44 (2006) 263–272
05/02/2023vascular lesions of head and neck , v.lakshmi
23
Haemangiomas usually appear soon after birth (though up to 30% may be present at birth proliferate during the first year of life involute during the childhood years (up to 12 years)according to the depth of the lesion as superficial deep compound haemangioma
05/02/2023vascular lesions of head and neck , v.lakshmi
24Superficial papillary dermisbright red macular or papular masses
Capillary/ strawberry haemangioma
DEEP reticular dermis or subcutaneous tissues bluish or relatively colourless masses cavernous haemangioma
COMPOUNDsuperficial and deep components capillary cavernous haemangiomas.
05/02/2023vascular lesions of head and neck , v.lakshmi
25Clinical presentation
Present at birth or within the first year of life Color depends on vessel type Bright red – purple Soft and compressible May present with bleeding, infection, lymphatic leakage Trauma may result in sudden enlargement Spontaneous hemorrhage Pain occurs in 50% of patients Sudden pain may occur from thrombosis
05/02/2023vascular lesions of head and neck , v.lakshmi
26NATURAL HISTORY
LIFE CYCLE - 3 PHASES
PROLIFERATIVE PHASE ( rapid growth 2wks – 1 yr ) INVOLUTING PHASE ( slow regression 1- 7 yrs ) INVOLUTED PHASE ( complete regression after 8 yrs)
Hall mark is PROLIFERATIVE phase followed by involution phase Involution begins at 6- 10 months complete by 10 yrs 50 % cases resolve by 5 yrs 70% cases by 7 yrs
05/02/2023vascular lesions of head and neck , v.lakshmi
27
05/02/2023vascular lesions of head and neck , v.lakshmi
28Histology• proliferating endothelial
cells• highly cellular pericytes• high mitotic activity • numerous mast cells• Vascular channels are
not prominent
proliferative phase
• endothelial cells are flattened
• cell turnover is normal • few mast cells• Vascular channels filled
with blood cells predominate
involutive phase
05/02/2023vascular lesions of head and neck , v.lakshmi
29Treatment
useful approach to the management of haemangiomas can be based on stage of the lesion (proliferative or involutive phase), type of lesion (superficial, deep, compound) management of residual deformity
Active intervention - disfiguring haemangiomas
05/02/2023vascular lesions of head and neck , v.lakshmi
30
Prednisolone is the first line drug of choice Steroids are useful only in the proliferative phase Interferon 2a – potentially serious side effects
05/02/2023vascular lesions of head and neck , v.lakshmi
31Proliferative phase
Only in infants Superficial haemangiomas - pulsed dye laser repeated at 4–6 weekly intervals later stages of proliferation acquire a thickness beyond the depth of penetration of yellow light lasers Interstitial potassium-titanylphosphate (KTP) (Nd:YAG)
05/02/2023vascular lesions of head and neck , v.lakshmi
32Involutive phase
wait and watch policy until 3–4 years of age. involute completely by 6 years (rapid involuters) - no further treatment 60% of cases slow involution – need treatment in 80% of cases Steroids are not effective against involuting haemangiomas Superficial lesions - small and intermediate size vessels - pulsed dye laser Larger vessels - copper bromide, Nd-YAG laser deep haemangiomas – Resection compound lesions - superficial component - laser photocoagulation deep - excised
05/02/2023vascular lesions of head and neck , v.lakshmi
33Residual deformity
adolescent and adult patients
common manifestations are telangiectasia, fibrofatty masses of tissue, epidermal atrophy.
05/02/2023vascular lesions of head and neck , v.lakshmi
34
TELANGIECTASIASMALL VESSELS
red blush pulsed dye laser
medium large vessels copper bromide, pulsed KTP laser
Nd:YAG laser
05/02/2023vascular lesions of head and neck , v.lakshmi
35Fibrofatty tissue
Excision can be more vascular than expected thermoscalpel and contact laser (Nd:YAG) Haemangiomas of the lip and nose
05/02/2023vascular lesions of head and neck , v.lakshmi
36Epidermal atrophy
Skin resurfacing with carbon dioxide laser and Erbium:YAG (Er:YAG) laser atrophic scarring in partially or completely involuted haemangiomas in children
Micro pigmentation (tattoo pigmentation) may be useful for areas of hypopigmentation to restore colour to the scarred skin or vermilion
05/02/2023vascular lesions of head and neck , v.lakshmi
37DRUG THERAPY
mixed hemangiomas, proliferative hemangiomas, hemangiomas that affect vital organs are lifethreatening.
05/02/2023
38
IMIQUIMOD novel immunomodifier, used for small and intermediate-sized hemangiomas located in inconspicuous sites with alternate day topical application, for a cycle of 3 to 5 monthsADVANTAGES ease of use, controllability, safety, lack of local irritation or systemic effectsDISADVANTAGE cause hyperpigmentation; thus care has to be taken for application on the face for aesthetic reasons
vascular lesions of head and neck , v.lakshmi
05/02/2023vascular lesions of head and neck , v.lakshmi
39
ORAL PREDNISOLONE (3.0–5.0 mg/kg) every other morning for 6 to 8 weeks. tapered after that for 2 or 3 weeks 2 or 3 cycles interval of 4 to 6 weeks. localized hemangiomas orbital or parotid lesions, intralesional steroids can be very effective.
TRIAMCINOLONE 1 to 2 mg/kg of body weight (maximum of 60 mg) at monthly intervals, depending on the age of the patient and size of the lesion.
05/02/2023
40PINGYANGMYCIN (bleomycin A5)
intralesionally for hemangiomas based specifically on a high sclerosing effect on vascular endothelium,
> 90% success rate12 and 49% complete resolution
IND : easy, safe, effective therapeutic modality cutaneous hemangiomas ,proliferative hemangiomas which respond poorly to steroids and/or
laser therapy.
vascular lesions of head and neck , v.lakshmi
05/02/2023vascular lesions of head and neck , v.lakshmi
41
The injection begins from 1 point of the lesion toward the center, infiltrates evenly within the lesion via change of the injection direction until the surface of the lesion appears pale
Compression is applied for 15 to 30 minutes after injection to prevent effusion of the solution repeated for 2-3 wks
Pingyangmycin hydrochloride (8 mg/syringe2% lidocaine normal saline dexamethasone (5 mg/1 mL).
05/02/2023vascular lesions of head and neck , v.lakshmi
42
each dosage is not more than 8 mg, and reduced accordingly for infants (1/4–2/3). cutaneous superficial or mucosal hemangiomas - 1.0 mg/mL
subcutaneous or deep hemangiomas - 1.5 to 2.0 mg/mL
05/02/2023
43VINCRISTINE
0.5 to 1.0 mg/ kg/ week IV over 6 weeks Infants with Kasabach–Merritt syndrome, which is caused by Kaposiform hemangioendothelioma, .
vascular lesions of head and neck , v.lakshmi
05/02/2023vascular lesions of head and neck , v.lakshmi
44
ALPHA-INTERFERON serious side effect of spastic diplegia, which is permanent and disablingBBLOCKERS propranolol for problematic hemangiomas with dramatic shrinkage and control of the
hemangiomas. There was no rebound noted, and toxicity was minimal
05/02/2023vascular lesions of head and neck , v.lakshmi
45
LASER THERAPY superficial proliferating hemangiomas. may accelerate the regression and reduce the size of the lesion, creating favorable situations
for subsequent treatments. If the lesion continues to enlarge during laser therapy, supplementary pharmacotherapy
should be considered.ADVANTAGE simplicity of use, which can be repeated at an interval of 2 to 4 weeks. choice of laser should be based on the location, size, and depth of the lesion.
05/02/2023vascular lesions of head and neck , v.lakshmi
46FLASH LAMP PUMPED PULSED DYE LASER
585 nm or 595 nm, selective destruction of the blood vessels, and is the only laser that delivers
photocoagulation of the targeted vessels while keeping the overlying skin intact.
INDIC : superficial hemangiomas those at the involution stage little effect on subcutaneous and deep-seated hemangiomas because of the limited
penetration depth
05/02/2023vascular lesions of head and neck , v.lakshmi
47
NEODYMIUM: YTTRIUM-ALUMINUM-GARNET (ND:YAG) 1064 nm penetration depth of up to 5.0 mm larger and up to 2 cm deep hemangiomas
05/02/2023vascular lesions of head and neck , v.lakshmi
48
PERCUTANEOUS LASER THERAPY deep hemangiomas cooling devices should be used to lower the temperature to protect the
epidermis from thermal damage effectiveness of laser therapy is 77% to 100% smaller the lesion, the better the result SIDE EFFECTS tissue necrosis and scarring .
05/02/2023vascular lesions of head and neck , v.lakshmi
49SURGERY
INDIC : located in the nose and lip that do not respond well to other treatments in the eyelids that impair sight and aesthetics, occurring on the forehead and scalp, repeated bleeding from the hemangiomas.
AIM : to remove or re-contour the residual deformity, scar hypertrophied abnormality, hyperpigmentation fibrofatty tissues to improve cosmetics and function
05/02/2023vascular lesions of head and neck , v.lakshmi
50COMPLICATIONS
Ulceration <5% of hemangiomas Usually with rapidly growing lesions that become secondarily infected Almost never occurs in vascular malformations Topical antibiotics +/- systemic abx Bleeding Spontaneous hemorrhage is rare May result from trauma
05/02/2023vascular lesions of head and neck , v.lakshmi
51Vascular Malformations
Normal rate of endothelial turnover “grow with the child” Subclassification based on predominant vessel: Lymphatic Capillary Venous Arterial
05/02/2023vascular lesions of head and neck , v.lakshmi
52Capillary (venular) malformations
port wine stain, capillary haemangioma made up of postcapillary venules within the papillary and superficial reticular dermis flat pink macules but darken and thicken with age, resulting in a cobblestone appearance result from altered neural modulation of the papillary plexus associated with Sturge–Weber and Klippel–Trenaunay syndromes
05/02/2023vascular lesions of head and neck , v.lakshmi
53 VENOUS MALFORMATIONS
present from birth and, unlike hemangiomas, they do not have a cycle of growth and subsequent spontaneous regression
They grow proportionately during infancy and childhoodCLINICAL FEATURES bluish, compressible, nonpulsating masses Extensive venous malformations can cause a localized intravascular
coagulopathy sclerosing agents used to destroy the vascular endothelium
05/02/2023vascular lesions of head and neck , v.lakshmi
54Factors implicated in varying response to treatment
Depth, Colour, Location of the lesion, Age at treatment Number of treatments
05/02/2023vascular lesions of head and neck , v.lakshmi
55Sclerosing agents
chemical agents (iodine or alcohol), osmotic agents (salicylates or hypertonic saline), DETERGENTS morrhuate sodium, sodium tetradecyl sulfate, polidocanol diatrizoate sodium anti-cancer drugs which change the surface tension of the cell, producing tissue maceration
05/02/2023vascular lesions of head and neck , v.lakshmi
56
VENOGRAM
High draining venous malformations<5 min in veins sodium morrhuate 5%, ethanol ( toxic liver <5ml)-
Low drainage venous malformation> 5min in veinsIntralesional pingamycin 1.5- 2 mg/dlMax dose – 8 mg
05/02/2023vascular lesions of head and neck , v.lakshmi
57ETHANOL:
Most effective Effective rate 100% Digital subtraction angiography (DSA)-guided percutaneous ethanol for grade 2 and 3 (>5 cm)
facial and cervical venous malformations
MRI classification of Goyal et al grade 2A, well defined, >5 cm grade 2B, ill defined, < 5 cm in diameter grade 3, ill defined, >5 cm in diameter
DISADV :
Pain Soft tissue odema Base of tongue ,
pharynx,larynx – prophylactic tracheostomy
05/02/2023vascular lesions of head and neck , v.lakshmi
58
acute inflammatory reactionformation of blood clots
Thrombosisfibrosis
occlusion of the malformed veinsresolution of the lesions
Care should be taken not to damage the facial nerves during treatment of parotid venous malformations
21-gauge butterfly needle 2/3 to 3/4 of the contrast agent BP,HR Monitered Dexamethsone tid before, after proced BP , kidney function test moniter vth IV RL, NAHCO3 ( hemoglobinuria) antibiotics
05/02/2023vascular lesions of head and neck , v.lakshmi
59VM
before immediately After 1 hr
05/02/2023vascular lesions of head and neck , v.lakshmi
60
VM - Sclerotherapy – 8 hrs, 12 hrs
05/02/2023vascular lesions of head and neck , v.lakshmi
61Nd:YAG laser therapy
superficial venous malformations deeper lesions in parotid, masseteric, and deep facial areas -severe damage of the overlying skin
will result in unwanted scarring 30 to 70 W/cm2 + cooling photocoagulates - avoiding damage to the facial nerves. larger and thicker lesions- pharynx and larynx- low-power laser at several times allows shrinkage
05/02/2023vascular lesions of head and neck , v.lakshmi
62Glomovenous malformation (GVM)
an autosomal condition characterized by multiple venous malformations in the skin. differ from standard venous malformations by being multiple, slightly raised, or blue or
bluish-purple in appearance. Histopathologically, presence of numerous glomus cells (abnormally formed smooth muscle
cells). located on chromosome 1p, which is called glomulin
05/02/2023vascular lesions of head and neck , v.lakshmi
63
surgical excision Sclerotherapy - sodium tetradecyl sulfate, polidocanol, and hypertonic saline Ablative therapy with argon and CO2 lasers is of potential benefit for small, superficial lesions.
05/02/2023vascular lesions of head and neck , v.lakshmi
64ARTERIOVENOUS MALFORMATIONS
AVMs of the head & neck region
Soft tissue plexiform hemangioma
arteriovenous fistulaintraosseous
central hemangioma
05/02/2023vascular lesions of head and neck , v.lakshmi
65EMBOLOTHERAPY
PURPOSE to control the growth of AVMs and frequent bleeding. key is to use sufficient liquid embolizing agents to eradicate the nidus. currently used liquid agents are ethanol N-butyl-2-cyanoacrylate (NBCA).
05/02/2023vascular lesions of head and neck , v.lakshmi
66Said to be complete :
For females with AVMs who are planning to become pregnant, it is best to do the embolization before pregnancy, because the hormonal changes during pregnancy may accelerate the progress of AVMs.
active bleeding has stopped localized pulsation - disappeared lesion - lighter in color expanded veins - normal new bone - cystic zones.
05/02/2023vascular lesions of head and neck , v.lakshmi
67Soft tissue AVMs
Infiltrativemixture of ethanol and
contrast at a ratio of 1:1Nidus
require absolute alcohol Fistularequire absolute alcohol .
EMBOLISATION
affect important anatomic structures with severe disfigurements, the most effective treatment is preoperative embolization and radical resection
05/02/2023vascular lesions of head and neck , v.lakshmi
68TREATMENT OF LYMPHATIC MALFORMATIONS
Lymphatic malformations can be divided into 2 types: macrocystic microcystic.The treatment options include surgery, sclerotherapy laser therapy
05/02/2023vascular lesions of head and neck , v.lakshmi
69Choice of Treatment Methods
Superficial oral mucosal
microcystic• Intralesional injection
of pinyangmycin (1.0 mg/ml)38
• Laser therapy
Deep-seated microcystic
• Preoperative intralesional injection of pinyangmycin
Macrocystic lymphatic
malformations • Ethanol • Doxycycline• Sodium tetradecyl
sulfate (STS),• Ok-432
05/02/2023vascular lesions of head and neck , v.lakshmi
70MACROCYSTIC LYMPHATIC MALFORMATIONS
• Pinyangmycin (1.5– 2.0 mg/mL)
• OK-432Intralesional
injection
• doxycycline • safe and effective methodPercutaneous
sclerotherapy
Diffuse- inflammatory reaction
Activate WBC
Release cytokines
Increase permeability of endothelium
FibrosisShrinkage of cystic
spaces
05/02/2023vascular lesions of head and neck , v.lakshmi
71Percutaneous sclerotherapy with Ethibloc (alcoholic solution of zein)
acts on the proteins destroying their
structure
triggering their clotting
obstruct vessels reduce the volume of
the malformation
direct effect on the internal surface on the
vesselsdamaging the cells that
form the internal layer of the vessels
occlusion
safe and effective procedure in the treatment of macrocystic and mixed lymphatic malformations.
05/02/2023vascular lesions of head and neck , v.lakshmi
72Macrocyst access
• ultrasound guidance and placement of a coaxial 5F pigtail catheter system• Massive lesions may accept larger catheters such as 8 to 10F size
• multilocular lesions, each macrocyst is treated with separate catheter • Following complete drainage of the macrocysts, contrast cystogram with fluoroscopy is performed to
document the native cyst volume,
• Following contrast aspiration, the macrocysts are treated with dual-drug chemoablation• 50% original volume sequential intracystic injections of STS 3% (2 minute dwell time) followed by aspiration
and injection of ethanol 98% solution (dwell time 15 minutes).
05/02/2023vascular lesions of head and neck , v.lakshmi
73STURGE WEBER SYNDROME
Neurocutaneous disorder Facial vascular malformation Port wine stain Post capillary venules V1/V2 distributions Leptomeninges Neurodevelopmental disorders Seizures Ocular symptoms Glaucoma, conjunctival/choroidal hemangiomas
ref : takeoka m. sturge-weber syndrome. medscape. may 2011
05/02/2023vascular lesions of head and neck , v.lakshmi
74Klippel-Trenaunay syndrome
Geographic capillary malformation
05/02/2023vascular lesions of head and neck , v.lakshmi
75Cutis marmorata telangiectatica congenita
noted at birth and may have a localized orgeneralized distribution. When localized, it often has a sharply segmental pattern
involving upper extremity
05/02/2023vascular lesions of head and neck , v.lakshmi
76. Blue rubber bleb nevus syndrome
a venous malformation located on the palm.
characteristic skin and gastrointestinal features.
05/02/2023vascular lesions of head and neck , v.lakshmi
77Proteus syndrome
hemihypertrophy and deformity of the foot, in addition to capillary malformation on abdomen
rare sporadic disorder that is characterized by soft tissue and bony hypertrophy of the hands and feet, hemihypertrophy, exostosis, cranial hyperostosis, visceral hamartomas including lipomas, vascular anomalies, and epidermal nevi.
05/02/2023vascular lesions of head and neck , v.lakshmi
78. Maffucci syndrome
Venous malformations and enchondromas
a rare sporadic genetic disorder typically comprising enchondromas and vascular anomalies
05/02/2023vascular lesions of head and neck , v.lakshmi
79Osler-Rendu-Weber syndrome
Hereditary hemorrhagic telangiectasia , characterized by mucocutaneous and visceral telangiectases and AVMs
05/02/2023vascular lesions of head and neck , v.lakshmi
80KASABACH MERRITT SYNDROME
Result of platelet trapping within the angioma and spleen Due to short platelet survival time, internal bleeding Infection can produce DIC and consumptive coagulopathy Occurs during proliferative phase Found in patients whose lesion > 5 cm
05/02/2023vascular lesions of head and neck , v.lakshmi
81Case : 1
Coil placed contrast medium was injected the varix was verified.
Coil placement (arrow) and no residual arteriovenous shunting were showed on the control angiography performed via the indewelling femoral arterial catheter.
13 months after
05/02/2023vascular lesions of head and neck , v.lakshmi
82
Post embolisisation angiogram
05/02/2023vascular lesions of head and neck , v.lakshmi
83Case 2
Axial CT scan with contrast, soft tissue (A), and bony (B) windows showing an intrabony nonhomogeneous mass
05/02/2023vascular lesions of head and neck , v.lakshmi
84
stage I AVM involving the left posterior mandible
05/02/2023vascular lesions of head and neck , v.lakshmi
85
patient 6 months after initial presentation now with stage II AVM involving the left posterior mandible
05/02/2023vascular lesions of head and neck , v.lakshmi
86
left posterior mandible stage II AVM after embolization with Onyx
05/02/2023vascular lesions of head and neck , v.lakshmi
87
AVM left posterior mandible 2 years after treatment with selective embolization and excision after removal of hardware
05/02/2023vascular lesions of head and neck , v.lakshmi
88
Patient 6 years after diagnosis and treatment of left posterior mandible AVM, with new-onset facial swelling from recurrence of AVM with involvement of left parotid.
05/02/2023vascular lesions of head and neck , v.lakshmi
89
left face AVM recurrence with no bone involvement but with extensive involvement of the left parotid gland. (A) Anteroposterior plane skull film. (B) Representative view of the AVM during angiography
05/02/2023vascular lesions of head and neck , v.lakshmi
90Case 3
Panoramic radiograph of 12year-old girl with stage II AVM involving the right posterior mandible.
05/02/2023vascular lesions of head and neck , v.lakshmi
91
Axial CT scan with contrast. Soft tissue (A) and bony (B) windows show an intrabony nonhomogeneous mass of the right posterior mandible
05/02/2023vascular lesions of head and neck , v.lakshmi
92
Right mandible AVM progressive fill
05/02/2023vascular lesions of head and neck , v.lakshmi
93
Selective embolisation Surgical excision
05/02/2023vascular lesions of head and neck , v.lakshmi
94references
Treatment guidelines for treatment of vascular malformations Haemangiomas and vascular malformations of the maxillofacial region—A review British
Journal of Oral and Maxillofacial Surgery 44 (2006) 263–272 Direct-Puncture Embolization of Intraosseous Arteriovenous Malformation of Jaws JOMS 2002 Surgical management of vascular lesions of the head and neck: a review of 115 cases Int. J.
Oral Maxillofac. Surg. 2011; 40: 577–583 Vascular Malformations and Their Treatment in the Growing Patient , clinics 2015 Vascular malformations ,Part II: Associated syndromes (Maria C. Garzon, MD,a Jennifer T. Huang,
MD,b Odile Enjolras, MD,c and Ilona J. Frieden, MDd New York, .
05/02/2023vascular lesions of head and neck , v.lakshm
i
95
THANK YOU