Abstract
Arteriovenous malformation （AVM） often progresses and recurs after treatment. The management of advanced AVM is frequently difficult. We herein report a case of a large AVM in the submandibular region that regrew 14 months after the initial surgery, controlled by a second surgery.
The patient was a 28-year-old man who was referred to our hospital with complaints of swelling in the submandibular region. A pulsating lesion measuring approximately 8 cm in diameter was found, and was diagnosed as AVM. The patient underwent surgical resection two days after arterial embolization. During the surgery, the feeding vessels of the AVM were ligated and cut at the distal position; however, diffuse bleeding from the surface of the AVM occurred. The AVM was attached to the hyoid bone, and profuse arterial bleeding from the hyoid bone occurred when the AVM was separated from the bone. The intraoperative blood loss was 1,458ml. The AVM regrew 14 months after the initial surgery, so we performed a second surgery without preoperative embolization. During the second surgery, the hyoid bone and feeding artery under the hyoid bone penetrating the hyoid bone were resected along with the AVM. The intraoperative blood loss this time was 1,039ml. No recurrence of the AVM was observed at three years and nine months after the second surgery. The present case suggests that the accurate ligation of all feeding vessels is important in order to resect AVM without recurrence.
