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SHORT COMMUNICATION Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 2  |  Page : 90
High-flow vascular malformation of the mandible


Department of Oral Surgery, Tamil Nadu Government Dental College, Chennai, India

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Date of Submission08-Jun-2006
Date of Decision20-Jan-2007
Date of Acceptance22-Jan-2007
 

How to cite this article:
Kumaravelu C, Vasudevan R, Uma Maheswari G, Suresh Kumar P, Balaji J, Pasupathy. High-flow vascular malformation of the mandible. Indian J Dent Res 2007;18:90

How to cite this URL:
Kumaravelu C, Vasudevan R, Uma Maheswari G, Suresh Kumar P, Balaji J, Pasupathy. High-flow vascular malformation of the mandible. Indian J Dent Res [serial online] 2007 [cited 2020 Oct 31];18:90. Available from: https://www.ijdr.in/text.asp?2007/18/2/90/32428
A 15-year-old female patient reported with uncontrolled bleeding from the oral cavity. She complained that the bleeding followed brushing of teeth, and the blood from the mouth 'shot up high to the ceiling like a fountain.' History revealed that this was the first incidence.

Clinical examination revealed an innocuous circumscribed gingival enlargement about 1 cm around the right mandibular first premolar with grade III mobility of the tooth. No expansion of mandible was present. The bleeding was spontaneous from the lingual gingival sulcus of the first premolar; and with pressure packing and styptics, hemorrhage was temporarily controlled. Hematological findings were within normal limits. Orthopantomography showed slight enlargement of inferior alveolar canal on the affected side. The increasing facial swelling, which was pulsatile, and the presence of bruit necessitated computerized tomography arteriography, [Figure - 1]a,b. It established the diagnosis as high-flow arteriovenous malformation of the right side mandible with feeder vessels from the right facial artery, lingual and inferior jugular vein. While the patient was being planned for elective surgery, she reported back to the casualty with fresh episode of bleeding, which was unstoppable by local measures. So, emergency surgical intervention was necessary to perform external carotid artery ligation to control bleeding, and segmental resection of the right side of the mandible with lesion was performed. Blood loss was significant, and 8 pints of blood transfused. Primary reconstruction was not done as priority was to manage the hemorrhage and stabilize the systemic status. Patient recovered uneventfully. Radiograph of the resected specimen confirmed enlargement of the inferior alveolar canal [Figure - 2].

High-flow vascular malformation of the mandible is extremely rare and is associated with significant morbidity and mortality secondary to uncontrollable bleeding. These lesions are often asymptomatic with no characteristic appearance on plain radiographs. As this case presented with spontaneous bleeding, it helped us in establishing the diagnosis. If not, we would have diagnosed this as a fibrous epulis around first premolar with grade III mobility, warranting excision of the growth and extraction of the tooth concerned. The consequences that could have resulted thereof are unimaginable.

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Correspondence Address:
J Balaji
Department of Oral Surgery, Tamil Nadu Government Dental College, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.32428

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    Figures

  [Figure - 1], [Figure - 2]

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