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Central / Peripheral Vascular Malformationincranio-Facial Region Accidentally Discovered. (Case Report)

1. Abstract 1.1. Objectives: The need for direct supportive decision for management of central Vascular Malformation (VM) in emergency and elective conditions. Case Presentation: A 19-year-old male patient was referred to the MaxilloFacial clinic with massive oral bleeding from the mucosal sulcus of the left side of the cheek at the level of upper first molar tooth following accidental trial of incision and drainage of suspected abscess in private clinic, the case managed in casualty unit and operated later on as a partial maxillectomy with ligature of facial artery. 1.2. Discussion: We present a very rare case with characteristics of central and peripheral VM, including the patient’s: clinical history; findings of examination; and radiographic and scanning examination. 2. Introduction Hemangiomas are benign vascular neoplasm’s characterized by an abnormal proliferation of blood vessels [1]. Cavernous Hemangiomas are benign proliferations of vessels that usually occur at or just after birth [2]. Intra-osseous Arterio-Venous Malformation (AVM) in the craniofacial region is rare [3]. Head trauma may have be the cause, localized headache can be seen with this pathology [4]. Intra-osseous vascular lesions are subdivided into hemangiomas and Vascular Malformations(VM) [5]. Its early detection and treatment are important as any minor trauma may result in fatal hemorrhage [6]. Hemangiomas and VM can cause significant morbidity and even mortality. Physicians often confuse these lesions. The nomenclature for classifying these lesions is often used interchangeably and inappropriately. Clinically significant malformations are uncommon. Both lesions are endothelial malformations [7]. VM are always present at birth and enlarge with growth and do not in volute and remain present throughout the patient's life [8]. Historically, lesions were named according to the size of the channels and the type of fluid content. Blood-containing lesions were called hemangiomas and were separated into capillary, strawberry, and cavernous on the basis of channel size. Lymph-containing lesions were referred to as lymphangiomas or cystic hygromas [7]. This classification system replaced by one described in 1982 by Mulliken and Glowacki [8]. Which separates endothelial malformations into hemangiomas and VM, on the basis of their natural history, cellular turnover, and histology [8]. A more pertinent issue is classifying vascular malformations as either low-flow or highflow lesions [9]. Surgical excision combined with intravascular embolization is treatment of choice for AVM with the knowledge that extensive AVM are still not curable [10]. Irradiation is suggested if the lesion is large or surgically inaccessible [11] with side effects such as damage to growth centers in developing patients and induction of neoplastic transformation [12]. Cryo-therapy have some measure of success in small lesions [13]. Embolization of large feeder vessels is also recommended under fluoroscopic