An Elderly Case with an Arteriovenous Malformation in the Neck Region Requiring Suture to Control Bleeding at the Base of the Tongue
2016 Volume 147 Pages 60-61
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2016 Volume 147 Pages 60-61
Arteriovenous malformations (AVMs) in the head and neck region pose therapeutic challenges. We report the case of an elderly patient in whom bleeding from an AVM at the base of the tongue was controlled by a figure-of-eight suture.
An 87-year-old woman suffering from pain in her mandible and oral bleeding was referred to the oral surgery department. She was diagnosed as having AVM based on the findings of enhanced computed tomography. The bleeding subsided without treatment.
Eight months later, the patient developed recurrent re-bleeding from the oral cavity and was referred to our department. She presented with expanded blood vessels in her mandible, neck and oral cavity. Endoscopy revealed exposed vessels at the base of the tongue. The vessels were considered to be the cause of the bleeding. The bleeding again subsided spontaneously. However, 6 days later, the patient suddenly vomited large amounts of blood. She was transported by ambulance to our hospital. Angiography showed that the AVM was supported by the bilateral facial and lingual arteries. We decided against interventional therapy as we could not advance the catheter through the meandering blood vessels. Eventually, the bleeding subsided spontaneously and the patient was discharged.
However, 25 days after her first visit to our department, the bleeding recurred. We decided to undertake surgical intervention in the operation room under general anesthesia. The bleeding point was grasped by mosquito forceps and was occluded with a figure-of-eight suture using 3-0 PDS II® under endoscopic guidance. Tracheotomy was performed to prevent suffocation in the event of a large amount of oral re-bleeding. Fortunately, no persistent bleeding or angiogenesis was noted. At three months after the operation, the hemoglobin value remains normal.
Under limited circumstances, suture hemostasis (finger-of-eight suture) is useful in the treatment of bleeding from an AVM in the head and neck region.
