ARTERIOVENOUS-MALFORMATIONS OF THE DENTAL ARCADES - THE PLACE OF ENDOVASCULAR THERAPY - RESULTS IN 12 CASES ARE PRESENTED

Twelve arteriovenous malformations of the dental arcades (AVMDAs) (sev en mandibular and five maxillary) were seen in our institution between 1977 and 1997, All these lesions consisted of true arteriovenous shun ts (of either nidus or fistulous type) involving the bone, with or wit hout soft tissue extension. Haemorrhage was present in eight patients (67%); either torrential, necessitating emergency embolization, or rec urrent and progressive. Teeth instability was detected in all patients and was the origin of the bleeding. All lesions were embolized, Lesio ns in nine patients were embolized with Polyvinyl Alcohol Particles (P VA): this helped to stabilize the situation but could not avoid recurr ences in all patients, necessitating complementary embolizations and o r surgery. The use of acrylic glue (N-Butyl-Cyano-Acrylate [NBCA] Hist oacryl) as the embolic agent has changed the results obtained tremendo usly, Eight patients have been treated with NBCA (five as complementar y therapy to PVA during later sessions and three at the first attempt) ; injection either via the transarterial route or direct transcutaneou s puncture (four patients) achieved a cure in four of these lesions (3 4%) with stability at long-term follow-up of all the other AVMs. Embol ization with glue represents the therapy of choice in these sometimes life-threatening lesions, achieving a cure if directed towards the oss eous venous lakes. Surgery often leading to facial mutilation and nece ssitating massive reconstruction should be avoided nowadays, at least as the initial therapy.