Endovascular Embolization for Arteriovenous Malformation of the Oropharynx : A Case Report

Abstract

  Arteriovenous malformations (AVMs) of head and neck (oropharynx) are relatively rare vascular anomalies that occasionally present with massive bleeding in the oral cavity. The management and treatment for oropharyngeal AVMs are difficult due to their variety and rarity. We herein report a patient with a ruptured AVM of oropharynx, which was successfully occluded by endovascular therapy.

  A 70-years-old man presented with intraoral hemorrhage. A CT scan demonstrated a giant oropharyngeal tumor, and a surgical biopsy was performed. After the procedure, bleeding from the lesion had occurred several times. Digital subtraction angiography (DSA) demonstrated an oropharyngeal AVM, mainly fed from the lingual artery and the facial artery, and drained into the common facial vein. Since there were concerns about dysphasia and mucosal necrosis after surgical resection or sclerotherapy for the AVM, endovascular embolization was performed. The AVM was embolized by injecting 25% to 33% NBCA from the several branches of the lingual artery (deep lingual artery, dorsal lingual artery) and the facial artery (ascending palatine artery). DSA and CT angiography after the endovascular therapy showed complete occlusion of the AVM, and he was discharged 11 days after the treatment without re-bleeding from the lesion.

  Oropharyngeal AVMs treated by endovascular therapy require long-term observation. However, endovascular embolization with NBCA against oropharyngeal AVMs may be safe and effective.