Entangled Aetiologies: A Case Report on Post Extraction Arteriovenous Malformation in Pregnancy

Arteriovenous Malformations (AVMs) are rare, high-flow vascular anomalies characterised by abnormal shunting between arteries and veins. These lesions present unique challenges in diagnosis and management due to their complex vascular anatomy, tendencies for recurrence, and potential complications. This case report discusses a 26-year-old postpartum female presenting with an AVM in the mandible, following a dental extraction during the second trimester of pregnancy. The lesion was initially managed conservatively with embolisation during pregnancy but showed significant progression postpartum, necessitating a multidisciplinary approach. Preoperative embolisation was performed using glue and Lipiodol, targeting branches of the right internal maxillary and facial arteries. This was followed by surgical resection and reconstruction using free fibula osteocutaneous grafts to restore function and aesthetics. Pathological examination confirmed the characteristics of an AVM, including fragmented elastic lamina and endothelial hyperplasia. This case underscores the importance of combining advanced diagnostic imaging, timely embolisation, and surgical intervention with aesthetic reconstruction to achieve optimal outcomes. Despite the unclear aetiology-whether trauma-induced, hormonally influenced, or congenital-the patient experienced favourable functional and aesthetic results with no recurrence at four months of follow-up. This report highlights the complexity of AVM management and reinforces the necessity of a multidisciplinary, multimodal approach for these challenging lesions.