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Kriwalsky Bleeding
Kriwalsky Bleeding
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ISSN 1865-1550
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Author's personal copy
Oral Maxillofac Surg
DOI 10.1007/s10006-014-0448-3
REVIEW ARTICLE
Abstract Severe hemorrhages of the oral cavity may be Mulliken and Glowacki based on clinical and histopathologi-
caused by arteriovenous malformations. This case report con- cal findings [1]. Hemangiomas and vascular malformations
cerns a 52-year-old healthy female who presented with a can be differentiated. Hemangiomas are benign tumors that
painful lower third molar and an extensive arteriovenous increase due to rapid mitotic cellular proliferation. They dem-
high-flow malformation of the floor of the right side of the onstrate a typical and well-defined life cycle of proliferation
mouth. During the extraction of the right lower wisdom tooth, and involution. Vascular malformations are present at the time
an episode of massive life-threatening bleeding occurred. of birth but may not be clinically evident [2]. The first symp-
Since the therapy for intraoral arteriovenous malformations toms of angiodysplastic lesions may occur during childhood
of the soft tissue is complex and often difficult to perform, the or puberty and are less frequent later in life. Vascular
modus operandi of the present case is presented, and a review malformations are characterized by the quantity of endothelial
of the literature is included. cells and structural abnormities of the vessels (arteries, veins,
lymphatic vessels, or a combination of these) [1]. They dem-
Keywords Life-threatening bleeding . Hemorrhage . Tooth onstrate no spontaneous regression. Based on the hemody-
extraction . Arteriovenous malformation namic criteria, “high-flow” and “low-flow” malformations
can be distinguished. “High-flow” malformations are lesions
that demonstrate an increased blood flow rate due to collateral
vessel formation and arteriovenous shunts. The initial symp-
Introduction toms may be mild, but they usually progress to findings such
as facial asymmetry, pain, otalgia, dental mobility, or sponta-
Angiodysplastic maxillofacial lesions are rarely encountered neous or potentially life-threatening hemorrhages around the
in clinical practice. They were classified according to teeth or from the mucosa [3].
M. S. Kriwalsky (*) : D. Papadimas : M. Kunkel
This report presents the case of a patient with life-
Department of Oral and Plastic Maxillofacial Surgery, threatening bleeding after wisdom tooth extraction due to an
Ruhr-University Bochum, In der Schornau 23-25, adjacent arteriovenous malformation, and it evaluates the
44892 Bochum, Germany international literature on this subject.
e-mail: marcus.kriwalsky@rub.de
P. Maurer
Private Practice of Oral and Maxillofacial Surgery, Case report
Wendalinusstr. 5-7, 66606 St. Wendel, Germany
A 52-year-old otherwise healthy female patient was referred
M. Brinkmann
Department of Radiology and Nuclear Medicine, by an oral surgeon for removal of the decayed right lower
Ruhr-University, In der Schornau 23-25, wisdom tooth to prevent the development of an abscess.
44892 Bochum, Germany Initially, the referring dentist was thinking about extracting
J. Jackowski
the tooth under outpatient conditions but finally decided to
Department of Oral Surgery, University of Witten/ Herdecke, refer the patient to the hospital. Since birth, an extensive
Alfred-Herrhausen-Str. 45, 58455 Witten, Germany arteriovenous malformation of the right tongue, floor of the
Author's personal copy
Oral Maxillofac Surg
Fig. 1 Intraoral view prior to treatment, the tongue of the patient showing Fig. 3 Digital subtraction angiography showing the right lingual artery
a vascular malformation on the right side and maxillary artery as feeding vessels
Author's personal copy
Oral Maxillofac Surg
References 12. Noel AA, Gloviczki P, Cherry KJ Jr, Rooke TW, Stanson AW,
Driscoll DJ (2000) Surgical treatment of venous malformations in
Klippel-Trenaunay syndrome. J Vasc Surg 32:840–847
1. Mulliken JB, Glowacki J (1982) Hemangiomas and vascular 13. Rodrigues D, Bourroul ML, Ferrer AP, Monteiro Neto H, Goncalves
malformations in infants and children: a classification based on ME, Cardoso SR (2000) Blue rubber bleb newus syndrome. Rev
endothelial characteristics. Plast Reconstr Surg 69:412–422 Hosp Clin Fac Med Sao Paulo 55:29–34
2. Kohout MP, Hansen M, Pribaz JJ, Mulliken JB (1998) Arteriovenous 14. Seckin U, Borman P, Ozoran K (2000) Clinical images: Maffucci’s
malformations of the head and neck: natural history and manage- syndrome. Arthritis Rheum 43:1672
ment. Plast Reconstr Surg 102:643–654 15. Saydjai R, Saydjari R, Guinto FC Jr, Wolma FJ (1990) Arteriovenous
3. Carneiro SC, Batista LL, Vasconcelos BC, Maranhao CA, Panazzolo malformation of the tongue. South Med J 83:1335–1337
G, Queiroz IV, Medeiros Junior R (2009) Massive oral hemorrhage 16. Slaba S, Herbreteau DJ, Haveri HS, Casasco A, Aymard A, Houdart
due to mandibular arteriovenous malformation treated with percuta- E, Aoun N, Riche MC, Enjolras O, Merland JJ (1998) Therapeutic
neous approach—a case report. J Oral Maxillofac Surg 67:2525– approach to arteriovenous malformations of the tongue. Eur Radiol 8:
2528 280–285
4. Brauer HU (2009) Unusual complications associated with third molar 17. Richter GR, Suen J, North PE, James CA, Waner M, Buckmiller LM
surgery: a systematic review. Quintessence Int 40:565–572 (2007) Arteriovenous malformations of the tongue: a spectrum of
5. Moghadam HG, Caminiti MF (2002) Life-threatening hemorrhage disease. Laryngoscope 117:328–335
after extraction of third molars: case report and management protocol. 18. Kluba S, Meiss A, Prey N, Ernemann U, Reinert S, Hoffmann J
J Can Dent Assoc 68:670–674 (2007) Arteriovenous malformation of the mandible: life-threatening
6. Heiland M, Weber M, Schmelzle R (2003) Life-threatening bleeding manifestation during tooth extraction. Mund Kiefer Gesichtschir 11:
after dental extraction in a hemophilia A patient with inhibitors to 107–113
factor VIII: a case report. J Oral Maxillofac Surg 61:1350–1353 19. Churojana A, Khumtong R, Songsaeng D, Chongkolwatana C,
7. Bouloux GF, Perciaccante VJ (2009) Massive hemorrhage during Suthipongchai S (2012) Life-threatening arteriovenous malformation
oral and maxillofacial surgery: ligation of the external carotid artery of the maxillomandibular region and treatment outcomes. Interv
or embolization? J Oral Maxillofac Surg 67:1547–1551 Neuroradiol 18:49–59
8. Gibbon WW, Pooley J (1990) Pathological fracture of the femoral 20. Watzinger F, Gössweiner S, Wagner A, Richling B, Milesi-Schobel
shaft in a case of Servelle-Martorell syndrome (phleboeclatic G, Hollmann K (1997) Extensive facial vascular malformations and
osteohypoplastic angiodysplasia with associated arterio-venous mal- haemangiomas: a review of the literature and case reports. J
formation). Br J Radiol 63:574–576 Craniomaxillofac Surg 25:335–343
9. Werner JA, Geisthoff UW, Lippert BM, Rudert H (1997) Treatment of 21. Ernemann U, Hoffmann J, Grönewäller E, Breuninger H, Rebmann
recurrent epistaxis in Rendu-Osler-Weber disease. HNO 45:673–681 H, Adam C, Reinert S (2003) Hemangiomas and vascular
10. Greinwald JH Jr, Burke DK, Bonthius DJ, Baumann NM, Smith RJ malformations in the area of the head and neck. Radiologe 43:958–
(1999) An update on the treatment of hemangiomas in children with 966
interferon alfa-2a. Arch Otolaryngol Head Neck Surg 125:21–27 22. Deng W, Huang D, Chen S, Zhang X, Li X, Li J, Chen X (2010)
11. Aydin A, Cakmakci H, Kovanlikaya A, Dirik E (2000) Sturge-Weber Management of high-flow arteriovenous malformation in the maxil-
syndrome without facial nevus. Pediatr Neurol 22:400–402 lofacial region. J Craniofac Surg 21:916–919