Therapeutic approach to arteriovenous malformations of the tongue

Abstract

Arteriovenous malformations (AVM) are developmental errors with a high complication rate because they are hemodynamically active. The aim of our study is to evaluate management of the rare subgroup of tongue AVM. From 1982 to 1994, 25 patients with AVM of the tongue presented to our department. All patients were discussed in our multidisciplinary staff consultation and were treated by embolization, surgery, or were followed-up clinically with no intervention. Thirteen patients were asymptomatic in a hemodynamically quiescent phase and did not require any kind of intervention. The 12 others underwent embolization procedures following which 6 became stable, 2 had complementary surgery, 1 was lost to follow-up, 1 had two minor bleeding episodes without the need for hospitalization, and 2 were improved. Arteriovenous malformations of the tongue must be followed clinically and treated only if they become active. Permanent embolization with a polymerizing liquid administered through supra-selective catheterization or by direct puncture of the malformation is recommended.

Arteriovenous Malformations of the Tongue: A Spectrum of Disease

“…Few case reports have described lingual AVM 3,4,10,11 . In this study, we have identified two clinical entities, focal lingual AVM and diffuse AVM with tongue involvement.…”

“…This is thought to occur as a result of incomplete resection of the nidus with rapid recruitment and collateralization of adjacent vessels. Embolization has also been shown to aggravate lesions by stimulating vascular “steal” from remaining collateral vessels 3,8 . In both cases, recurrence is quickly apparent as the “nidus” shifts location.…”

“…Many treatments have fallen out of favor because they have proven either ineffective or shown to exacerbate disease. Surgical management has remained the most likely chance for cure 1–3 …”

“…Despite evidence that embolization can temporarily control disease, recurrence and progression are common, with only a few authors suggesting that clinical cure can be achieved with this modality alone. Surgical management (block resection) after selective embolization of small feeding vessels has gained the most favor as the best chance for cure of AVMs 1–3 . Regardless, caution must always be exercised when performing embolization of AVM.…”

“…The majority of reported cases have been shown to occur within the midface (cheek, nose, maxilla, and upper lip) and mandible 1,2 . Few authors have described their experience with AVM involving the tongue 3 . Of those reported, lingual AVM are often compartmentalized in the context of larger head and neck malformations with multiple arterial feeders, identified by angiography and magnetic resonance imaging (MRI) scans, contributing to the progression of disease 3,4 .…”