Torrential intraoral bleed in a mandibular arteriovenous malformation: Resuscitation under nonoperating room settings

Abstract

Arteriovenous malformation (AVM) of the head and neck, though rare, can present significant clinical challenges, particularly during dental procedures. This case report details the acute management of a 7-year-old girl with an AVM in the right mandible, with sudden, severe, torrential intraoral hemorrhage during an angioembolization procedure, necessitating immediate airway management and hemodynamic stabilization in a nonoperating room anesthesia (NORA) setting. Persistent bleeding led to a multidisciplinary intervention, including external carotid artery ligation and right hemimandibulectomy, achieving hemostasis. The case underscores the importance of meticulous planning, readiness with resuscitation and airway management equipment, and coordinated efforts among anesthesia and surgical teams in NORA settings to manage such critical situations effectively.

Keywords

• arteriovenous malformation
• challenging airway management
• emergency resuscitation
• nonoperating room anesthesia
• torrential intraoral bleed