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Arteriovenous malformation of the tongue/ dental courses
1. ARTERIOVENOUS MALFORMATION OF
THE TONGUE – A CASE REPORT
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
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2. A male Patient aged
27years reported to our
department with a chief
complaint of swelling
on the tongue since 12
years.
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3. The swelling was of pin head sized to start with and
gradually increased to attain the present size
No h/0 surfaces changes associated symptoms
trauma
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5. PAST MEDICAL, SURGICAL & DENTAL
HISTORY
not contributing to chief complaint & history
FAMILY HISTORY
no similar lesions among others.
GENERAL PHYSICAL EXAMINATION
no similar lesions elsewhere.
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7. HARD TISSUE EXAMINATION
NAD
SOFT TISSUE EXAMINATION
A solitary well defined purple
colored spherical swelling
anterior 2/3 of the tongue
involving dorsal ventral and
lateral surface measuring
1x1.5cm in size
No discharge or surfaces changes
INTRAORAL EXAMINATION
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8. ON PALPATION:
The swelling was soft
in consistency
non-tender
non-fluctuant
compressible
non-pulsatile
no fluid thrill
not fixed to the
underlying structures.
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11. COLOR DOPPLER ULTRASONOGRAPY
A well defined multicystic
lesion of size
1.2x1.0cm .
Both arterial and venous
flow noted within,
predominantly of arterial
type.
A dilated feeding artery
noted posterior to the
lesion.
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17. INTRODUCTION
DEFINITION: Arteriovenous malformations are
abnormal, tangled collections of dilated blood vessels
that result from congenitally malformed vascular
structures in which arterial afferents flow directly into
venous efferents without the usual resistance of an
intervening capillary bed. (Merck manual 15edn)
SYNONYMS
ACRAL ARTERIOVENOUS TUMOR
ARTERIOVENOUS ANEURYSM
CIRSOID ANEURYSM
RACEMOSE HEMANGIOMAwww.indiandentalacademy.com
18. ETIOLOGY
Unknown etiology
Endocrine and inflammatory stimuli may activate
situated as deep or superficial mass
Congenital AV fistula - common type.
(A.william Barrett,Paul M.Speight,OOOOE 2000;90;731-8)
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19. CLINICAL FEATURES
SITE
Lower lip > Commisure > Tip of the tongue > Upper lip > Cheek submucosa >
Floor of the mouth > Lateral border of the tongue.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:731-8)
SUPERFICIAL LESIONS
SIGNS
Nevertheless troublesome.
Raised , can enlarge , present for months to years.
SYMPTOMS
Asymptomatic
Solitary ,although multiple lesions can occur.
No systemic complicationswww.indiandentalacademy.com
20. DEEP LESIONS
Produce serious systemic signs and symptoms
(extensive arteriovenous shunting and soft tissue hypertrophy),
Diagnosis made in conjugation with clinical and
radiographic examination.
(A.William Barrett,Paul M.Speight,OOOOE 2000;90:731-8)
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21. INVESTIGATIONS
DOPPLER
ULTRASONOGRAPHY: - most widely used
- non-invasive
- vascularity of lesion can be assessed
BIOPSY : - probability of profuse bleeding
(Hiroshi yoshida, Hiroshi yusa, El ueno, J Oral maxillofacial surgery 1995;53;369-374)
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22. MAGNETIC RESONANCE
IMAGING vascularity cannot be assessed
COMPUTED TOMOGRAPHY vascularity cannot be assessed
ARTERIOGRAPHY: - Valuable in assessing delineating feeding vessels
assessing size & location
- Invasive nature can cause complications
- allergic reactions to contrast media
(Hiroshi yoshida, Hiroshi yusa, El ueno, J Oral maxillofacial surgery 1995;53;369-
374)
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23. TREATMENT MODALITIES
ASYMPTOMATIC
rarely indicated.
SYMPTOMATIC
SCLEROTHERAPY followed by surgical resection.
Agents : sodium tetradecyl sulphate
ethanolamine,
ethenol (95-100%)
(J.Oral Maxillofacial Surgery 2005;63;1484-1488)
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24. LASER THERAPY
Tunable flashlamp pulsed-dye laser(585-nm wavelength)
is widely used
SUPERSELECTIVE ARTERIAL OR RETROGRADE VENOUS
EMBOLISATION
preoperatively will not diminish the extent of the
resection,also minimize intraoperative bleeding.
EMBOLIZATION
must be in the epicenter , carried out 24 to 72hours
before resection.
(J.Oral Maxillofacial Surgery 2005;63;1484-1488)
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25. CONCLUSION
AVM of the tongue: a very rare entity
Hindrances with complex classifications of diagnosis
many treatment options
Advanced imaging modalities like ultrasonography and
arteriography have made the task easy.
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