The management of mandibular arteriovenous malformation using the surgical therary with preoperative embolization

구강악안면영역의 혈관질환은 매우 위험한 질환으로 술자에게 주의를 요한다. 여기에는 혈관종과 혈관기형이 있으며 정확한 기왕력과 적절한 임상검사로 감별진단이 가능하지만 진단적인 혈관조영술이 요구되기도 한다. 치료에는 경화술, 냉동술, 방사선치료, 결찰술, 혈관색전술, 레이저치료 및 외과적 접근법이 있다. 특히 동정맥기형에서의 외과적 접근법에는 많은 논란이 있는데, 병소의 경계를 포함한 완전한 제거가 요구된다는 의견과 단순한 소파술만으로 치료가 가능하다는 상반된 경우가 있다. 본 증례는 Gelfoam을 이용하여 술전 혈관색전술 시행한 후 건전한 협측 피질골을 거상, 내부 종물의 소파술을 시행한 후 거상한 피질골을 재위치시킴으로서 악골의 외형을 잘 보존한 경우로 술후 기능적 및 심미적으로 양호한 결과를 얻었기에 보고합니다.

Vascular lesions of the oral and maxillofacial region are as challenging to clinicians as they are devastating to patients. Two basic entities of hemangioma and vascular malformations exist as vascular lesions. The differential diagnosis bfetween these two lesions can be done through the history and the phyisical findings. Some lesions may be difficult to evaluate; therefore, a diagnostic angiography may be employed. Management of maxillofacial vascular malformations consists of sclerotherapy, cryotherapy, radiotherapy, intralesional ligation, embolotherapy, laser therapy, and surgical treatment. The surgical management of vascular malformations, particularly the arteriovenous malformation, remains as controversial an issue as any in contemporary oral and maxillofacial surgery. On one hand, there is a surgically aggressive school of thought that advocates major segmental or en bloc resecton of the arteriovenous malformation. The opposite point of view is clearly reflected by the numerous case reports that appear in the literature of arteriovenous malformations managed by simple curettage. We experienced a large mandibular arteriovenous malformation with an intact buccal cortex that was treated with curettage with the lateral decortication and reposition of the decorticated buccal bone plate after preoperative embolization using Gelfoam and without arbitrary sacrifice of the uninvolved cortical margin that could provide stability of the mandibular arch. The postoperative result was good aesthetically and functionally.