Angiographic Embolization with Histoacryl in Combination with Direct Injection of Bone Cement of an Intraosseous Venous Malformation of the Mandible: Report of a Case with 22-Year Follow-Up

Abstract

Vascular malformations of the maxillofacial region are unusual, and they occur more rarely in bone than in soft tissue. Mandibular intraosseous vascular lesions represent 0.5-1.0% of all bone tumors, and they are classified as venous malformation, lymphatic malformation, arterial malformation, arteriovenous malformations, and arteriovenous fistulae. Venous malformation is the most common vascular malformation, accounting for 44-64% of all vascular malformations, and is considered a low-flow malformation. Endovascular therapy as selective angiographic embolization is considered as the first-choice treatment associated or not with emboli injections with a success rate of 70%, and this evades mutilating surgery and related sequelae. We report a case of mandibular venous malformation on a 45-year-old female complaining of unilateral swelling of the left body of the mandible with facial deformation. The computed tomography scan images and the T1-weighted MR images showed a lesion that expresses an expansible lesion in the spongy bone of the left of the mandible with a buccal cortical rupture. Signal voids were not identified, suggesting a low-flow vascular lesion. The T2-weighted images exposed hypersignals; accordingly, a vascular lesion was suspected. The treatment was done under locoregional analgesia; after selective angiography, direct histoacryl injection was completed, followed by bone cement injection. The patient was followed yearly since1998. Radiological images of 10-year follow-up MRI showed a stabilization of the lesion without any new extensions. The panoramic radiograph after 22 years showed a bone formation inside the body of the mandible. The long follow-up period and the absence of any complications are favorable for the adopted treatment plan.