A systematic approach on the frequency of cleft lip/palate in pediatric patients with leukemia.

PURPOSE: The purpose of this study was to reveal the frequency between cleft lip/palate and leukemia in pediatric patients by a systematic analysis of the current literature. MATERIALS AND METHODS: Electronic search on three database (PubMed, Web of Science, Cochrane) was carried out using the following keywords: cleft lip, cleft palate, facial cleft, oral cleft, orofacial cleft, leukemia, acute myeloid leukemia, acute lymphocytic leukemia, lymphoma. Studies published until March 2020 reporting an association between leukemia and cleft lip/palate (CL/P) were included in our research. RESULTS: Five articles (2 case-controls, 3 cohorts), met the inclusion criteria. Case-control studies involved 268 patients with acute lymphocytic leukemia (ALL) and 177 patients with acute myeloid leukemia (AML), of which 9 patients had CL/P. The cohorts studies involved 10 patients with ALL, of which 6 patients with CL/P, 2 patients with cleft palate and 1 patient with cleft lip and palate. CONCLUSION: This research was able to indicate a limited evidence of the association between CL/P and leukemia. In order to draw a clear conclusion, studies with larger cohorts are needed to establish this correlation.

Effect of bimaxillary orthognathic surgery on dysfunction of the temporomandibular joint: a retrospective study of 500 consecutive cases.

We investigated the effect of bimaxillary orthognathic surgery on symptoms in the temporomandibular joint (TMJ) and predictive factors for postoperative dysfunction. A total of 500 patients with different craniofacial deformities who were having bimaxillary orthognathic surgery were assessed for overjet, overbite, maximal mouth opening, maximal protrusion, maximal lateral movement to both sides, and symptoms of TMJ dysfunction (pain on palpation, clicking, or crepitus) before operation and one year postoperatively. The panoramic radiographs taken on the same dates were assessed for reduction in the height of the ramus. Other variables were age, sex, segmentation of the maxilla, and additional genioplasty. Changes in the symptoms of dysfunction were investigated with the McNemar test. Measurements of the maximum mandibular movements taken preoperatively and postoperatively were compared using the paired t test. Multivariate logistic regression was used to assess the influence of the variables on symptoms preoperatively and postoperatively. The effect of occlusal stability (overjet and overbite) on postoperative symptoms in the TMJ was investigated with the unpaired t test. Women and class II patients had significantly more pain on palpation preoperatively, and a significant reduction in pain on palpation and clicking after operation. Predictive factors were preoperative crepitus for postoperative pain, and preoperative clicking for postoperative clicking. Patients with and without symptoms showed no significant differences in overjet and overbite postoperatively. Condylar resorption was found in 29 patients (5.8 %), and only 14 of them had symptoms in the TMJ. In patients with no preoperative symptoms or radiological abnormalities of the condyle, condylar resorption was rare (0.8 %). Orthognathic surgery has a beneficial effect on dysfunction of the TMJ as it reduces pain and clicking considerably. Patients should be informed, however, that TMJ disorders could still develop even if they had no symptoms preoperatively.

Odontogenic cervical necrotizing fasciitis, etiological aspects.

INTRODUCTION: Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft-tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential. MATERIALS AND METHODS: In this study, we selected 55 patients with confirmed cervical necrotizing fasciitis of odontogenic origin, treated in the Clinic of Oral and Maxillofacial Surgery in Cluj-Napoca during January 1996-December 2012. RESULTS: In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-72.69]), the rest of the patients having 1-4 types of systemic disorders; type 2 diabetes mellitus was the most frequent type of underlying systemic disorder. From the appearance of the first symptoms until the presentation for treatment, a time interval of 2-30 days elapsed. During this time period, 78.18% (95% confidence interval [CI] [65.49-89.06]) of the patients received antibiotic treatment, but without results. Mandibular molars were the most frequent starting point of the disease, and the submandibular space was the first affected by the disease, 47.27% (95% CI [32.76-61.79]). Bacteriological exams showed that facultatively aerobic/anaerobic G + bacteria were the most frequently identified (72.22% [58.21-83.60]). CONCLUSION: The odontogenic lesions of the lower molars, complicated by submandibular space infections, are the most frequent starting point of odontogenic cervicofacial necrotizing fasciitis. Delayed surgical treatment and strict antibiotic therapy play an important role in favoring the development of odontogenic necrotizing fasciitis.

Natural chemopreventive alternatives in oral cancer chemoprevention.

We studied the effect of grape seed extract Burgund Mare (BM) on oral carcinogenesis and compared it with that of curcumin (CU). Wistar rats were divided into six groups (n = 10): 4-nitro-quinoline-1-oxide (4NQO) oral carcinogenesis was induced to groups 1 - 5; groups 2 and 3 received BM and CU respectively during initiation and groups 4 and 5 BM and CU during post-initiation of carcinogenesis; group 6 represented the negative control group. Total malondialdehyde (MDA) and reduced glutathione (GSH) were assayed fluorometrically in oral tissue (gingival, jugal, palatal, lingual mucosa) and serum. Histopathological exam was performed and a dysplasia score given to each oral mucosal lesion. Ki67, cyclin D1, p63, Bcl2 and p53 were immunohistochemically evaluated. BM and CU reduced tissue MDA values elevated by 4NQO (P = 0.000). The difference between CU and BM effect was significant in the initiation (P = 0.02) but not in the post-initiation phase of carcinogenesis (P = 0.58). Tissue GSH levels decreased by 4NQO (P < 0.001) were not significantly modified by BM or CU. Serum MDA levels increased by 4NQO (P = 0.000) were significantly lowered by CU (P = 0.04) and BM (P = 0.04) during initiation and by CU during post-initiation of carcinogenesis (P = 0.01). CU was more potent than BM during post-initiation of carcinogenesis (P = 0.01). Serum GSH lowered by 4NQO (P = 0.55) was significantly decreased by BM and CU (P < 0.012), with no significant difference between groups receiving BM or CU. Moderate dysplasia was the most advanced dysplasia induced and gingival localization the most frequent. Both BM and CU lowered dysplasia scores, with BM being the most efficient during post-initiation of carcinogenesis (P = 0.001). Ki67, cyclin D1, p63, Bcl2 and p53 expression increased with dysplasia scores. BM showed chemopreventive properties during initiation and post-initiation of oral carcinogenesis, reducing local and general oxidative stress and the intensity of dysplasia. During post-initiation of carcinogenesis BM and CU exhibited similar effects.

Secondary extracranial meningiomas extending into the paranasal sinuses.

Meningiomas are well-recognized tumors of the central nervous system. Extracranial meningiomas, secondarily extended into the paranasal sinuses, are rare tumors, comprising approximately 2% of all meningiomas. Extracranial meningiomas of the paranasal sinuses may present a diagnostic and the rapeutic challenge. We present a retrospective review comprising three cases and discuss the clinical presentation, imaging findings,diagnostic evaluation, and treatment options. The localizations included the frontal sinus, the ethmoid sinus, the sphenoid sinus and even the maxillary sinus. Complete surgical resection was achieved in one patient; meanwhile deliberate subtotal tumor resection was performed in the other cases in order to avoid severe neurological damage with sufficient tumor control.

In vivo behavior of surface modified Ti6Al7Nb alloys used in selective laser melting for custom-made implants. A preliminary study.

The objectives of this study were to test the biocompatibility and to evaluate the osseointegration of Titanium-Aluminum-Niobium (Ti6Al7Nb) alloy used in the manufacturing of personalized implants with selective laser melting (SLM) technology and to compare the growth viability of osteoblastic-like cells on different Ti6Al7Nb alloy samples (plain, coated with hydroxyapatite or SiO2-TiO2) implanted into the cranial bone of Wistar rats. In terms of biocompatibility, the cone-beam computer-tomography head scans taken at the moment of sacrifice of each group (one, two and three months) showed no implant displacement, no osteolysis and no liquid collection around the implants. At one month, around all types of implants new bone formation was noticed, although around the plain Ti6Al7Nb implant a large amount of powder debris was present. Still, no inflammatory reaction was seen. At two months, the distance between the implants and the calvarial bone margins diminished. A thin layer of fibrous tissue was noticed around the Ti6Al7Nb implant coated with hydroxyapatite but no bone contact was achieved. In the group sacrificed at three months there was still no bone contact, but noticeable were the SiO2-TiO2. In the group sacrificed at three months SiO2-TiO2 particles detached from the implant and completely integrated in the tissue were noticeable. All results suggested that the Ti6Al7Nb alloy with or without infiltration is well biologically tolerated.

Posteroanterior cephalometric changes in subjects with temporomandibular joint disorders.

OBJECTIVES: The aim of the study was to establish the changes in posteroanterior cephalometric variables in subjects with temporomandibular joint disorders (TMDs). METHODS: Posteroanterior cephalograms of 61 subjects (age range 16-36.6 years, standard deviation 4.88 years) were used to determine cephalometric differences. Subjects were classified according to the Research Diagnostic Criteria for Temporomandibular Joint Disorders into three groups: unilateral TMD, bilateral TMD and no TMD. 14 linear and angular measurements were assessed on the posteroanterior cephalogram. For assessing facial asymmetry, the asymmetry index for bilateral measurements was calculated between the right and the left side. In cases with unilateral TMD, the asymmetry index was calculated using the difference between the unaffected and affected side. The differences among multiple groups were analysed using the one-way analysis of variance test and Scheffé post hoc test. RESULTS: 47 subjects were females (77%) and 14 were males (23%). 19 subjects had unilateral TMDs and 16 subjects had bilateral TMDs. The asymmetry index of the distance from the horizontal plane to the antegonion was higher in subjects with unilateral TMD than in patients with bilateral or no TMD (p < 0.05). Also, the asymmetry index of the distances from the vertical plane to the condyle (p = 0.05), gonion (Go) (p = 0.0004), antegonion (p = 0.002) and chin (Ch) (p = 0.02) was higher in subjects with unilateral TMDs. The asymmetry index of the O point-Go-Go' and O point-Ch-Ch' angles differed significantly in subjects with unilateral TMDs (p < 0.05). CONCLUSIONS: Unilateral TMDs are associated with changes in posteroanterior cephalometric measurements. The assessment of posteroanterior cephalometric variables could be used as a key factor for evaluating the presence of TMDs.

Comparison of cone beam CT device and field of view for the detection of simulated periapical bone lesions.

OBJECTIVE: We aimed to assess the diagnostic accuracy of different cone beam CTs (CBCTs) and the influence of field of view (FOV) in diagnosing simulated periapical lesions. METHODS: 6 formalin-fixed lateral mandibular specimens from pigs were used for creating 20 standardized periapical bone defects. 18 roots were selected for the control group. Three CBCT devices [Accuitomo 3D® (Morita, Kyoto, Japan), NewTom 3G (Quantitative Radiology, Verona, Italy) and Scanora® (Soredex, Tuusula, Finland)] and three FOVs (NewTom 3G® FOV 6, 9 and 12 inches) were used to scan the mandible. Five observers assessed the images, using a five-point probability scale for the presence of lesions. Specificity, sensitivity and areas under the receiver operating characteristic (ROC) curves were calculated. RESULTS: Sensitivity ranged from 72% to 80%. Specificity ranged from 60% to 77%. A difference in scoring between Scanora and the other two devices existed only in the control group. ROC analysis for different FOVs showed a decreased sensitivity with an increasing FOV, but this difference was not significant. CONCLUSION: the control group, there was a difference between the CBCT devices regarding their specificity. FOV size did not show any difference in diagnostic performance. In cases in which conventional radiographic methods in combination with clinical evaluation are not sufficient, CBCT may be the method of choice to assess periapical pathology. CBCT examinations should be complementary to a clinical examination and FOV adaptation can be utilized to keep the dose to the patient as low as possible.

Osteonecrosis of the jaws associated with the use of bisphosphonates. Discussion over 52 cases.

BACKGROUND: Osteonecrosis of the jaws is increasing worldwide in patients treated with bisphosphonates. STUDY DESIGN: A retrospective review of 52 patients who were treated during 2007-2010 for bisphosphonate related maxillofacial symptoms of the jaws was conducted. Patient characteristics and other factors that influenced the disease process were studied. RESULTS: Thirteen patients received bisphosphonates for the prevention or treatment of osteoporosis; 39 for preventing bone metastases from malignant tumors. Thirty-six patients were females (age range 32-87 years, median 64 years); 16 were males (age range 30-81 years, median 73.5 years). Bisphosphonate used was ibandronic acid in four cases, alendronate sodium in 14 cases, and zoledronic acid in 34 cases. Mean bisphosphonate treatment period was 22.44 months (95%CI 19.33-25.55). Thirty patients received intravenous, 22 received oral bisphosphonate. The average period until occurrence of maxillofacial symptoms was 6 months (range 0.5-24 months) in subjects with intravenous bisphosphonate and 12.26 months (range 0.25-36 months) in subjects with oral bisphosphonates (p=0.011). CONCLUSIONS: The risk of bisphosphonate related osteonecrosis of the jaws is very high twelve months after oral administration and six months after intravenous administration in patients who have a trigger point in the jaws area. A proper monitoring of patients receiving bisphosphonates can reduce the risk of osteonecrosis and can prevent complications.

Histopathological aspects and local implications of oxidative stress in patients with oral lichen planus.

Aerobic life is connected with continuous production of free radicals, particularly reactive oxygen species (ROS). Cells posses an enzymatic and non-enzymatic antioxidant system to maintain redox homeostasis. Oxidant-antioxidant imbalance resulting in excessive accumulation of ROS is defined as oxidative stress. Oral lichen planus (OLP) is a chronic inflammation of unknown etiology. Several researchers suggest that oxidative stress is implicated in the pathogenesis of this disorder. The aim of this study was to evaluate the histopathological alterations and the status of local oxidative stress and antioxidant defense system in patients with OLP. We evaluated and compared the local levels of oxidative stress biomarkers malondialdehyde (MDA) and glutathione (GSH) in patients with OLP with that of normal controls. Increased levels of MDA and decreased levels of GSH suggest the idea of oxidative stress implication in the pathogenesis of oral lichen planus.

The effect of distraction rate on bone histological and histomorphometrical properties in an ovine mandible model.

UNLABELLED: Lengthening the mandible by distraction osteogenesis (DO) is nowadays a well-recognized technique in maxillofacial surgery. This study compared two different distraction rates and evaluated histological and histomorphometrical properties of the distracted bone in an experimental ovine mandible model with the goal of elaborating a universally accepted distraction protocol. STUDY DESIGN: Tissue blocks of regenerated bone were harvested from twelve young adult sheep. DO was performed on the mandibular midline after five days of latency period. The sheep were divided into two groups. The first group underwent activation of 0.8 mm÷day during 12 days resulting in 9.6 mm of new bone while the second group followed a geometric rate pattern of 0.2 mm - three days, 0.4 mm - three days, 0.8 mm - three days and 1.6 mm - three days resulting in 9 mm of new bone. The regenerated bone was histologically and histomorphometrically analyzed after 30, 45 and 60 days of consolidation. The relative osteoid volume (OV÷TTV) was significantly increased in the geometric rate distraction group (p=0.015) comparing with linear distraction group while the relative bone volume (BV÷TTV) was significantly increased in the linear distraction group (p=0.019) compared to the geometric distraction group.

Craniofacial resection for malignant tumors of the paranasal sinuses.

OBJECTIVE: To review the experience with craniofacial resection for malignant tumors of the anterior skull base and analyze prognostic factors for survival. MATERIAL AND METHODS: Between 1996 and 2008, 64 consecutive patients with malignant tumors of the anterior skull base underwent craniofacial resection. Different parameters were analyzed to study their relationship with survival: age, sex, pathology, orbital involvement, dural involvement, status of the surgical margins, adjuvant radiotherapy, and whether the treatment was done before or after surgery. Survival analysis was carried out with the Kaplan-Meier product limit method and comparison between groups was performed by the log-rank test. Factors identified in the univariate analysis were then entered in the multivariate analysis using the Cox regression model in order to identify predictive factors of survival. RESULTS: For the entire group survival rates were 47% at 5 years. The highest survival was observed in patients with estesioneuroblastoma and the lowest in melanoma cases. Dural involvement and orbital clearance are predictors of poor survival. CONCLUSION: The improved survival and minimal morbidity associated with craniofacial resection make it the approach of choice for anterior skull base tumors.

Serum changes induced by intramedullar experimental administration of bisphosphonates.

Bisphosphonates, stable analogues of pyrophosphate, have the ability to bind to bone molecules, possessing anti-resorbtion properties influenced by the radicals linked to the carbon group of their structure. Bisphosphonates link to the hydroxyapatite of the mineral surfaces and are selectively internalized by osteoclasts, whose activity they inhibit, jeopardizing the osteoblastic activity. The purpose of this study is to determine the influence of intramedular administration (at the hip bone) of bisphosphonates on the serum values of alkaline phosphatase, total Ca, Ca2+, proteins and serum osteocalcin in a lot of experience Wistar rats. Fifteen Wistar rats of experience, five in the control group and 10 in the experimental group. All rats underwent surgery to create a bone defect with a 1.5 mm diameter bone-bur at the right femur transcortical through the medullar canal. Rats from experimental group were divided into two groups: group A, who received Zometa 1 mL single dose intramedular, intraoperative and group B, who received Zometa 1 mL in divided doses daily, 0.1 mL for 10 days. 3 mL of blood from the frontal sinus were collected from each subject at 24 hours, 14 days and 21 days postoperatively. From the blood samples were determined: alkaline phosphatase [U/L], seric proteins [g/dL], total Ca [mmol/L, mg/dL], osteocalcin [mmol/L]. The data were statistically analyzed using the ANOVA test. We found an increase in alkaline phosphatase [U/L] in all groups studied. In group B there was a significant decrease in total Ca levels [mg/dL] throughout the experiment compared with controls (11.82→10.36→9.25 mg/dL; 2.95→2.59→2.31 mmol/L; p=0.001). Ca2+ has changed significantly both in group A (1.18→1.25→1.25 mmol/L; p=0.01) and group B (1.21→1.24→1.13 mmol/L; p=0.02). Serum proteins were significantly reduced both in the control group (9.4→8.5→8.1 g/dL; p=0.03) and the experimental groups A (9.3→8.5→8.3 g/dL; p=0.01) and B (9.9→7.6→7.3 g/dL; p=0.0008). At each stage of bone development, multiple factors act in a coordinated manner that leads to increased local metabolic processes, acting both on the process of bone resorption and bone repair. Healing processes are initiated within 24 hours in both studied groups and the control group; at 14 and 21 days the bone healing processes are compromised directly proportional to the administration manner and dose of bisphosphonates.

Bimaxillary distraction osteogenesis--an effective approach for the transverse jaw discrepancies in adults.

Severe dental crowding in adult patients is one of the features of disparity between the size of the teeth and the jaws. It is most frequently found in cases with a transverse hypoplasia of the maxilla and the mandible. The traditional orthodontic approach is extraction of teeth or arch expansion, both of them with major esthetic disadvantages for the patients. The surgically assisted maxillary expansion (SARME) and the mandibular midsymphyseal distraction osteogenesis procedures open new horizons for the orthodontists and maxillofacial surgeons in the effort to solve the esthetic demands of the patients with dental crowding and severe transversal discrepancy. The amount of surgical expansion is of higher magnitude and stability then the one achieved in orthodontic cases. The case presented here highlights the importance of the surgical procedure followed by the orthodontic therapy due to the enhancement in occlusion, dental alignment and facial morphology.

Tissue engineered bone versus alloplastic commercial biomaterials in craniofacial reconstruction.

This research was developed in order to demonstrate the tissue engineering method as an alternative to conventional methods for bone reconstruction, in order to overcome the frequent failures of alloplastic commercial biomaterials, allografts and autografts. Tissue engineering is an in vitro method used to obtain cell based osteoinductive bone grafts. This study evaluated the feasibility of creating tissue-engineered bone using mesenchymal cells seeded on a scaffold obtained from the deciduous red deer antler. We have chosen mesenchymal stem cells because they are easy to obtain, capable to differentiate into cells of mesenchymal origin (osteoblasts) and to produce tissue such as bone. As scaffold, we have chosen the red deer antler because it has a high level of porosity. We conducted a case control study, on three groups of mice type CD1--two study groups (n=20) and a control group (n=20). For the study groups, we obtained bone grafts through tissue engineering, using mesenchymal stem cells seeded on the scaffold made of deciduous red deer antler. Bone defects were surgically induced on the left parietal bone of all subjects. In the control group, we grafted the bone defects with commercial biomaterials (OsteoSet, Wright Medical Technology, Inc., Arlington, Federal USA). Subjects were sacrificed at two and four months, the healing process was morphologically and histologically evaluated using descriptive histology and the golden standard - histological scoring. The grafts obtained in vivo through tissue engineering using adult stem cell, seeded on the scaffold obtained from the red deer antler using osteogenic medium have proven their osteogenic properties.

The influence of expansion on intraoperative bone blood flow in multisegmental maxillary osteotomies: an experimental study.

The aim of the presented study was to investigate the effect of maxillary expansion in multisegmental Le Fort I osteotomies on bone blood flow. Five sheep underwent a three-piece total maxillary osteotomy. Bone blood flow was measured intraoperatively by laser Doppler flowmetry in the premaxilla, the lateral segments and the mandible before osteotomy, after osteotomy and segmentation as well as after 4mm, 8mm and 12mm expansion with a Hyrax screw. A significant reduction in blood flow was seen after osteotomy and segmentation with a factor of 3.10 and between 4mm and 8mm expansion with a factor of 1.81. No significant differences could be found between 0mm and 4mm widening or between 8mm and 12mm widening. These results suggest that expansion of more than 4mm in multisegmental osteotomies enhances the risk of avascular sequelae. As greater maxillary widening has been carried out in many cases without avascular complications, further research on additional factors, influencing the recovery of perfusion, is needed.

Intraoperative blood loss in bimaxillary orthognathic surgery with multisegmental Le Fort I osteotomies and additional procedures.

Autologous blood donation is not currently recommended by most authors for routine bimaxillary osteotomies. There are few data about bimaxillary procedures with multisegmental maxillary osteotomies. Our aim was to investigate the effect of additional osteotomies and iliac crest grafts on operative blood loss. A total of 225 consecutive patients having bimaxillary multisegmental osteotomies during a three-year period (January 2006-January 2009) were examined to see if their haemoglobin concentration and packed cell volume were reduced. The influence of iliac crest grafts, additional osteotomies (genioplasty, malar osteotomy, iliac crest graft, anterior mandibular segmental osteotomy), operating time, age, and sex were assessed. Neither age nor sex influenced blood loss, whereas operating time correlated significantly with reductions in haemoglobin concentration and packed cell volume. Blood loss was significantly higher in the group who had additional procedures (p 0.001 for haemoglobin concentration and packed cell volume) than in the group who had no additional procedures, whereas there were no significant differences among the three subgroups who had additional procedures (additional osteotomies, iliac crest grafts, or both procedures). Four patients who had additional procedures required transfusion, whereas no blood was given in the group who had no additional procedures. Because the transfusion rate was so low, we could make no general recommendation for preoperative blood donation in such cases.

Accuracy of maxillary positioning in bimaxillary surgery.

The aim of the study was to investigate the accuracy of a modified pin system for the vertical control of maxillary repositioning in bimaxillary osteotomies. The preoperative cephalograms of 239 consecutive patients who were to have bimaxillary osteotomies were superimposed on the postoperative films. Planned and observed vertical and horizontal movements of the upper incisor were analysed statistically. The mean deviations of -0.07 mm (95% confidence intervals (CIs) -0.17 to 0.04 mm) for the vertical movement and 0.12 mm (95% CI -0.06 to 0.30 mm) for the horizontal movement did not differ significantly from zero. Comparison of the two variances between intrusion and extrusion of the maxilla did not differ significantly either (p=0.51). These results suggest that the modified pin system for vertical control combined with interocclusal splints provides accurate vertical positioning of the anterior maxilla in orthognathic surgery.

Dental white spots associated with gastro-esophageal reflux in orthodontic and orthognathic surgery patients.

Gastro-esophageal reflux is a gastrointestinal disorder that might cause irreversible damages to the hard tissues of the teeth. The aim of this article is to report two cases of patients with severe dental demineralization associated with gastro-esophageal reflux during orthodontic and combined orthodontic-orthognathic surgery treatment. Diagnosis and prevention aspects are highlighted and discussed.

[Treatment of arterio-venous high-flow vascular malformations of the mandible]. / Tratamentul malformatiilor vasculare arterio-venoase de flux înalt ale mandibulei.

Arterio-venous vascular malformations (AVM) rarely occur in craniofacial bones. The most frequent location has been reported in the mandible. The first clinical evidence of the lesions can be a fatal hemorrhage, occurring spontaneously or subsequent to dental therapy. Lack of knowledge about these lesions among specialists dealing with the oral and maxillofacial regions can lead to fatal complications. The study presents the successful multidisciplinary management of two cases of mandibular AVM using embolization, sclerotherapy and bone reconstruction, a major challenge owing to the substantial risk of morbidity, recurrence by recanalization and revascularization, neurologic deficits and mortality. There were no complications over a follow-up period of 12 years.