ENDOVASCULAR - Carotid & Neurovascular Intervention
Embolization of the Arteries of the Lower Jaw with Massive Bleeding from the Aneurysmal Bone Cyst
Sergey Vladimirovich Sokolov1, Irina E Nikolaeva2, Vladimir V. Plechev2, Albina Enikeeva3, Igor Dmitriev4, Inna E. Yamanayeva2, Igor V. Buzaev5
Republican Cardiac Centre, Russian Federation1, Republican Centre of Cardiovascular Diseases, Russian Federation2, RKC, Russian Federation3, Republican Cardiology Center, Russian Federation4, Bashkir State Medical University, Russian Federation5,
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
The girl of 8 years turned to the dentist with bleeding from the gum in the area of 4.6 tooth. This tooth was removed. Started profuse bleeding from the hole of the extracted tooth. The girl has received an embolization of a. alveolaris inferior on the right and the tamponade of the hole. The bleeding was stopped. Two days later, bleeds again and is transferred to the Republican Cardiology Center of Ufa for embolization of blood vessels supplying the cyst.
Relevant Test Results Prior to Catheterization
CT of the facial skull: expansive, multiple osteolytic damages to the lower jaw on the right and multiple fluids in the cystic area (Fig. 1). In the projection of the lower alveolar artery on the right, a foreign body repeating its course (the state after occlusion of the lower alveolar artery on the right)
The hemoglobin level is 80 g/l.
Relevant Catheterization Findings
Angiography of the right external carotid artery (ECA): hypervascular formation of the lower jaw, the blood supply from the right a. facialis.
Angiography of the left ECA: hypervascular formation of the lower jaw on the right through collaterals from the left a. alveolaris inferior and a. facialis.
The patient is transferred to the Republican Cardiology Center of Ufa for the embolization of blood vessels supplying the cyst.
Transfemoral access with local anesthesia performed an angiography of the external carotid artery on the right with a JR 5F catheter: a highly vascular formation of the lower jaw on the right was detected, the blood supply from the right a. facialis. A. alveolaris inferior is rightly embolized earlier and does not contrast. Using the Terumo Progreat microcatheter, PVA-100 micron «COOK» embolization material performed selective embolization of a.facialis on the right (Fig. 3). Because the right arterial pool of the lower jaw anastomoses well with the left, it was decided to perform selective angiography of the external carotid artery on the left. Hypervascular formation of the lower jaw on the right was revealed, abundantly feeding through a network of collaterals from the left a. alviolaris inferior and a. facialis. Successive selective embolization of these arteries with PVA-100 micron «COOK» material was performed (Fig.4). Bleeding from the gum stopped and during the observation in our center for 1 day did not renew. After embolization, the girl was transferred to the Republican Children's Clinical Hospital in Ufa for further treatment and observation, where after 2 days an extended curettage of the cystic formation of the lower jaw on the right was performed. After surgery, the pain was not observed, bleeding from the gums was not noted.
Curettage and wide bone resection can be complicated by heavy bleeding. Bleeding from an aneurysmal bone cyst after embolization was not observed, and during extended curettage, blood loss was only 10 ml. The postoperative result was good aesthetically and functionally.It is recommended that preoperative embolization of the blood supply arteries be performed to avoid excessive bleeding during surgery. Multiple bone septum can also cause relapse due to incomplete curettage.Embolization is an effective procedure in the treatment of the aneurismal bone cyst and may be included in the main treatment method.