Vascular lesions of the maxillofacial region: a case report and review of the literature.

There is frequently lack of understanding and apprehension among dental practitioners treating patients with vascular lesions of the oral and maxillofacial region. Arteriovenous malformations are rare lesions which can easily be misdiagnosed yet produce the very dramatic clinical presentation of severe life threatening oral bleeding. Much of this apprehension likely stems from a lack of understanding of these anomalies, including lesion behavior/ characteristics, clinical work-up, and treatment paradigms. A comprehensive, in depth review of the full spectrum of vascular lesions of the maxillofacial complex is beyond the scope of this review. The purpose of this article is to provide a comprehensive review of the diagnosis, treatment, and risks associated with these complex vascular anomalies and provide a case report. In 1982, Mulliken and Glowacki published a landmark article proposing characterization of vascular defects based on biologic and pathologic differences. Their work differentiated between two major categories of vascular lesions: hemangiomas and vascular malformations. Different categories, names, and treatment options have been advocated over the years with multiple outcomes. They can occur in various areas throughout the body, with 60 percent being located in the head and neck. The true mechanism of pathogenesis of vascular anomalies is still unclear. Embolization and surgery is often combined for extended cases to improve their facial contour and oral function. We present the case of a 29-year-old female that is 36 weeks pregnant and presented to University Hospital after having significant bleeding from her oral cavity. She was found to have a gingival lesion associated with a radiolucency in the right posterior mandible. During her stay she had an episode of acute bleeding that required an emergent exploration, embolization, and resection secondary to an Arteriovenous Malformation associated with the Inferior Alveolar Artery. We will discuss the presentation, treatment provided, and outcome of this patient. We will also cover the diverse group of congenital vascular malformations, and their pathologic, clinical, and radiologic diagnosis and management.