A Case of High-Flow-type Arteriovenous Malformation in the Mandible and Submandibular Region

Arteriovenous malformation (AVM) refers to abnormal arteriovenous anastomoses with vascular morphological changes. We report a case of high-flow-type AVM that we successfully treated in collaboration with the Neurosurgery Department. The patient was a 24-year-old man. At the age of 13 years, he noticed a swelling in the right submandibular region. At the age of 18 years, he noticed that the swelling had enlarged and consulted our hospital’s Neurosurgery Department. He was given a diagnosis of high-flow-type AVM and underwent endovascular embolization twice. Later, the swelling started to enlarge again, and the patient was referred to our department for surgery. Initial examination revealed a normal-colored, pulsatile, right submandibular mass with a 130-mm major axis. Computed tomography showed an AVM extending from the right submandibular region to the mandible, up to the middle of the base of the skull. Endovascular coil embolization was performed at the Neurosurgery Department. Extirpation of the AVM, right hemimandibulectomy, and immediate reconstruction with a titanium plate were performed with the patient under general anesthesia. Two weeks after surgery, the patient was capable of oral ingestion, had a good overall condition, and was discharged. It is important that the treatment of AVMs depends on their classification and stage. Accurate diagnosis allows a high rate of curative treatment.