Head and Neck Imaging

Arteriovenous malformation, head and neck

high-flow vascular malformation, due to a congenital abnormal communication between an artery and a vein, bypassing the normal capillary bed. Based on structural criteria, three large groups can be distinguished: truncal fistulae (arising from major arterial branches), diffuse arteriovenous malformations (often found in the limbs, showing multiple connections between arteries and veins), and localized arteriovenous malformations (see vascular malformation head and neck).

In the head and neck, high-flow vascular malformations are quite rare, in contrast to low-flow vascular anomalies. These high-flow vascular malformations are sometimes detected soon after birth. They grow with the child, and years may go by before they pose a threat to the patient. Symptoms depend on the location; they may give rise to tinnitus, pain, trismus, recurrent epistaxis and other symptoms. Destruction of nearby osseous structures is possible. When located in the mandible or maxilla, they may give rise to an unexpected and very serious haemorrhage after dental extraction (Fig.1.)

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Fig.1

Thirteen-year-old girl, showing massive arterial bleeding after extraction of a left mandibular molar. a. Axial CT image of mandible shows large lytic area in left mandible; a tooth is seen floating in the lesion. Note large vessel (arrows) running into widened mandibular foramen. b. Nonselective carotid arteriogram shows vascular malformation (arrows), supplied by the facial, lingual and inferior alveolar artery; early venous drainage is visible (courtesy by Joseph Schoenaers, MD, Leuven, Belgium).
Arteriovenous malformation, head and neck, Fig.1 (a)
Arteriovenous malformation, head and neck, Fig.1 (b)