DOI:

10.37988/1811-153X_2022_2_68

Treatment tactics of vascular malformations of the head and neck depending on the quantitative assessment of the preoperative examination

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Authors

  • T.Z. Chkadua 1, PhD in Medical Sciences, head of the Maxillofacial Surgery Clinic
    ORCID ID: 0000-0001-8270-8843
  • L.M. Baisova 1, maxillofacial surgeon in the Department of reconstructive maxillofacial and plastic surgery
    ORCID ID: 0000-0001-8281-3715
  • A.G. Nadtochiy 1, PhD in Medical Sciences, full professor of the X-Ray diagnostics Department
  • M.N. Bolshakov 1, PhD in Medical Sciences, maxillofacial surgeon in the Department of reconstructive maxillofacial and plastic surgery
    ORCID ID: 0000-0002-1126-2159
  • D.L. Weise 1, PhD in Medical Sciences, ultrasonographer
  • 1 Central Research Institute of Dental and Maxillofacial Surgery, 119021, Moscow, Russia

Abstract

To date, the diagnosis and treatment of patients with vascular malformations remain topical. The authors were the first to introduce a method of objective (quantitative) assessment of the degree of vascularization of the affected tissues, as well as velocity characteristics on the basis of which the tactics and assessment of treatment efficacy were determined. The purpose of the work was to increase the efficiency of treatment of patients with vascular malformations of the head and neck.
Materials and methods.
In 2019-2021, 98 patients (27 men and 71 women) from 18 to 74 years of age with vascular malformations in the head and neck region were examined and treated. Based on the results of MSCT angiography and ultrasonography, patients were divided into 4 groups: I - 19 patients with high-vascularized (X-ray density >70 HU) fast-flow vascular malformations (peak systolic blood flow rate >20 cm/s); II - 27 patients with low-vascularized (≤70 HU) fast-flow malformations; III - 20 patients with high-vascularized slow-flow malformations (≤20 cm/s); IV - 32 patients with low-vascularized slow-flow malformations. All patients were operated according to the recommendations for each group: I - embolization and thermal excision; II - thermal excision; III - piercing, sclerosing, compression; and IV - thermal excision/sclerosing.
Results.
The following data were obtained based on instrumental studies (MSCT-AG, ultrasound) before and after surgical treatment: reduction of peak blood flow velocity in the nidus (Vps) by 39.9% in group I, 62.5% in group II, 30.7% in group III and 76.2% in group IV study. Devascularization level after treatment: 59.7% in group I, 47.8% in group II, 32.4% in group III, and 46.8% in group IV. Complications in the form of massive intraoperative bleeding requiring transfusion of blood components were seen in 6 cases in group I and 2 cases in group III. Bleeding in the postoperative period, which required additional surgical intervention - 5 cases in group I and 3 cases in group III. Partial necrosis in the postoperative area - 1 case each in groups I, II and IV, 5 cases in group III. Paresis of the mimic muscles was observed in 2 cases in groups I and II. Paralysis of the mimic muscles - 1 case in group I.
Conclusion.
The recommended methods proved to be good in practice and showed a high degree of vascular malformation devascularization, which in our opinion is a priority in the treatment of this category of patient.

Key words:

vascular malformations, arteriovenous malformations, venous malformations, maxillofacial region

For Citation

[1]
Chkadua T.Z., Baisova L.M., Nadtochiy A.G., Bolshakov M.N., Weise D.L. Treatment tactics of vascular malformations of the head and neck depending on the quantitative assessment of the preoperative examination. Clinical Dentistry (Russia).  2022; 25 (2): 68—73. DOI: 10.37988/1811-153X_2022_2_68

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Received

May 18, 2022

Accepted

June 8, 2022

Published on

June 1, 2022