Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible
Background: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subseq...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2018-05-01
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| Series: | Indian Journal of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.4103/ijps.IJPS_13_18 |
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| author | Parvathi Ravula Srikanth Rangachari Rammurti Susarla Laxman Sambari Srinivas Saraswathi Jammula |
| author_facet | Parvathi Ravula Srikanth Rangachari Rammurti Susarla Laxman Sambari Srinivas Saraswathi Jammula |
| author_sort | Parvathi Ravula |
| collection | DOAJ |
| description | Background: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subsequent reconstructions. With the advent of advanced multidisciplinary techniques aimed at definitive therapy, surgical resection and primary reconstruction can provide an ideal anatomical and functional cure. There are no previous reports on primary resection and reconstruction for life-threatening haemorrhage from high flow AVM of the mandible. Aim: We discuss our approach aimed at definitive therapy in life-threatening intraoral bleeding from large high flow AVM of the mandible. Subjects and Methods: Four patients were managed for life-threatening intraoral bleeding during 2015–2017. Compression was applied over the bleeding point before the airway could be secured by endotracheal tube. Under general anaesthesia, the external carotid artery (ECA) was temporarily occluded using an umbilical tape loop ligature to control the bleeding. Emergency selective embolisation was done, followed by curative resection and primary mandible reconstruction using free fibula flap. Outcome assessed. Results: Temporary occlusion of the ECA successfully controlled the bleeding immediately and facilitated selective embolisation and definitive therapy. All the four cases were successfully reconstructed with a good outcome. There was no recurrence during the follow-up period. Conclusion: In life-threatening intraoral bleeding from large high flow AVM of the mandible, emergency selective embolisation followed by curative resection and primary reconstruction is safe in achieving an ideal cure. |
| format | Article |
| id | doaj-art-ec5f45b2484147f1848bc9f4e6ec3e07 |
| institution | OA Journals |
| issn | 0970-0358 1998-376X |
| language | English |
| publishDate | 2018-05-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Plastic Surgery |
| spelling | doaj-art-ec5f45b2484147f1848bc9f4e6ec3e072025-08-20T02:04:44ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Plastic Surgery0970-03581998-376X2018-05-01510222223010.4103/ijps.IJPS_13_18Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandibleParvathi Ravula0Srikanth Rangachari1Rammurti Susarla2Laxman Sambari3Srinivas Saraswathi Jammula4Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, IndiaDepartment of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, IndiaDepartment of Radiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, IndiaDepartment of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, IndiaDepartment of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, IndiaBackground: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subsequent reconstructions. With the advent of advanced multidisciplinary techniques aimed at definitive therapy, surgical resection and primary reconstruction can provide an ideal anatomical and functional cure. There are no previous reports on primary resection and reconstruction for life-threatening haemorrhage from high flow AVM of the mandible. Aim: We discuss our approach aimed at definitive therapy in life-threatening intraoral bleeding from large high flow AVM of the mandible. Subjects and Methods: Four patients were managed for life-threatening intraoral bleeding during 2015–2017. Compression was applied over the bleeding point before the airway could be secured by endotracheal tube. Under general anaesthesia, the external carotid artery (ECA) was temporarily occluded using an umbilical tape loop ligature to control the bleeding. Emergency selective embolisation was done, followed by curative resection and primary mandible reconstruction using free fibula flap. Outcome assessed. Results: Temporary occlusion of the ECA successfully controlled the bleeding immediately and facilitated selective embolisation and definitive therapy. All the four cases were successfully reconstructed with a good outcome. There was no recurrence during the follow-up period. Conclusion: In life-threatening intraoral bleeding from large high flow AVM of the mandible, emergency selective embolisation followed by curative resection and primary reconstruction is safe in achieving an ideal cure.http://www.thieme-connect.de/DOI/DOI?10.4103/ijps.IJPS_13_18high flow arteriovenous malformation mandiblelife-threatening intraoral bleedingprimary free fibula reconstructiontemporary external carotid artery occlusion |
| spellingShingle | Parvathi Ravula Srikanth Rangachari Rammurti Susarla Laxman Sambari Srinivas Saraswathi Jammula Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible Indian Journal of Plastic Surgery high flow arteriovenous malformation mandible life-threatening intraoral bleeding primary free fibula reconstruction temporary external carotid artery occlusion |
| title | Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible |
| title_full | Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible |
| title_fullStr | Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible |
| title_full_unstemmed | Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible |
| title_short | Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible |
| title_sort | primary free fibula reconstruction in life threatening haemorrhage from high flow arteriovenous malformation of mandible |
| topic | high flow arteriovenous malformation mandible life-threatening intraoral bleeding primary free fibula reconstruction temporary external carotid artery occlusion |
| url | http://www.thieme-connect.de/DOI/DOI?10.4103/ijps.IJPS_13_18 |
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