Intraosseous Embolotherapy of Central Arteriovenous Malformations in the Jaw: Long-Term Experience With 8 Cases

Liu, Denggao; Ma, Xuchen; Zhao, Fuyun; Zhang, Jianguo

doi:10.1016/j.joms.2009.04.088

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 11 , Pages 2380-2387, November 2009

Intraosseous Embolotherapy of Central Arteriovenous Malformations in the Jaw: Long-Term Experience With 8 Cases

Denggao Liu, SMD
- Associate Professor, Department of Oral Radiology, Peking University, School and Hospital of Stomatology, Beijing, China
- Address correspondence and reprint requests to Dr Liu: Department of Oral Radiology, Peking University School and Hospital of Stomatology, 22 Zhongguancun Nandajie, Haidian District, Beijing 10081, P. R. China
Xuchen Ma, DDS, PhD
- Professor and Chairman, Department of Oral Radiology and Center for TMD, Peking University, School and Hospital of Stomatology, Beijing, China
Fuyun Zhao, MD
- Professor, Department of Oral and Maxillofacial Surgery, Peking University, School and Hospital of Stomatology, Beijing, China
Jianguo Zhang, MD
- Professor and Vice Chairman, Department of Oral and Maxillofacial Surgery, Peking University, School of Stomatology, Beijing, China

Purpose

To investigate the long-term effects of direct intraosseous histoacryl embolotherapy on central arteriovenous malformations (AVMs) of the jaw.

Materials and Methods

Eight patients with central AVMs of the jaw (3 in the maxilla and 5 in the mandible) were treated with direct intraosseous histoacryl injection. These AVMs exhibited cystic radiolucency, with (n = 5) or without (n = 3) honeycombed component. On angiography, all the AVMs exhibited a large intraosseous nidus with multiple suppliers and drainages. The intraossous lesions were percutaneously punctured with an 18- to 20-gauge needle, and NBCA diluted 30% to 40% with iodized oil was injected during venous compression.

Results

Postembolic arteriograms showed that all the AVMs were completely or nearly completely devascularized after single or multiple injections at the initial treatment. The follow-up period ranged from 3 to 8 years. Two AVMs experienced postembolic curettage and were anatomically cured. Three AVMs were anatomically cured after 1 to 3 sessions of embolotherapy. The other 3 AVMs were clinically cured after 1 (n = 2) to 4 (n = 1) sessions of embolotherapy. There were no procedure-related severe complications.

Conclusions

Direct intraosseous glue embolotherapy can be a simple and safe technique for endovascular management of central AVMs in the jaw and is particularly effective in an emergency. Complete reossification of the intraosseous nidus can be anticipated if a complete occlusion is obtained.