Extensive facial arterio-venous malformations; combined approach, embolization followed by surgical reconstruction

Background: Arteriovenous malformations (AVMs) are composed of an abnormal communication between arterialand venous channels without intervening capillary bed. In the face, they commonly present with asymmetry, bleeding, tooth mobility and headache. The most successful treatment to date is embolization followed by surgical excision. Objectives: To evaluate the safety and efficacy of embolization followed by surgical reconstruction in the treatment of extensive facial AVMs. Patients and Methods: In this study we present the outcome of treatment of 25 patients presented with extensive facial AVMs and admitted in the department of plastic and reconstructive surgery at Tanta University Hospital in the period from January 2016 to July 2021. Our treatment strategy wasembolization guided by digital subtraction angiography followed by surgical excision. Results: Twelve patients had one anatomic facial subunit affected by the lesion while nine cases had two subunits affected and four patients had 3 subunits affected. The average length of the widest dimension of the lesion was 6cm. Mostof our cases (19 of 25) were in Schobinger stage 2 at the initial presentation. All our patients were followed for at least 1 year and none of them showed any evidence of recurrence of the lesion during the follow-up period. All our cases had controlled disease. Conclusion: Preoperative embolization followed by surgical excision is the ideal treatment for extensive AVMs of the face.