Tooth extraction in the area of an arteriovenous malformation: a case report

Vascular malformations and vascular tumours represent two distinct entities according to the classification of vascular anomalies. Unlike vascular tumours (except rare congenital haemangiomas), vascular malformations are present at birth and grow with the development of the child. Vascular malformations with arterial component are considered as high-flow lesions and could be life-threatening due to uncontrolled haemorrhage after tooth extraction. This paper reports a safe tooth extraction in a 58-year-old female with arteriovenous malformation (AVM) [Cho type IIIb] of the left floor of the mouth, tongue, inferior lip, buccal, chin, anterior cervical and submandibular region (Schobinger class 3). The patient had metabolic syndrome. Her main complaint was pain in the left mandibular region. Unusual bleeding from the periodontal sulcus of the teeth 36 developed after attempt of division of Sharpey's fibres. The extraction procedure was interrupted immediately. Haemostasis was achieved with compression manoeuvre. Diagnosis of AVM with mandibular bone involvement was established by cone-beam computed tomography, magnetic resonance imaging, digital supraselective and computer tomography angiography. The patient refused treatment of the vascular malformation prior the extraction of the tooth. Preoperative embolisation of the AVM (biosphere 40–120 μm, BeadBlock 100–300 μm, PVA contour 45–150 μm) and consecutive tooth extraction were performed. The postoperative course and six months follow-up were uneventful. To summarise, adequate knowledge about AVM of all dental practitioners is mandatory in order to avoid a possible life-threatening complications.