Arteriovenous fistula after temporomandibular joint arthroscopy treated with precipitating hydrophobic injectable liquid: case report and literature review

INTRODUCTION: Arteriovenous fistulas (AVFs) are abnormal connections between the arterial and venous systems, bypassing the capillary network and causing high-flow shunting. While AVFs can be congenital, spontaneous, or traumatic, trauma remains the most common cause. Although iatrogenic AVFs after temporomandibular joint (TMJ) procedures are rare, their recognition is crucial due to potential complications such as hemorrhage, thromboembolism, and high-output cardiac failure. This report presents a rare case of an AVF following TMJ arthroscopy and discusses its management using superselective arterial embolization with Precipitating Hydrophobic Injectable Liquid (PHIL). CASE REPORT: A 24-year-old man with TMJ internal derangement underwent TMJ arthroscopy. After the procedure, massive pulsatile bleeding occurred, leading to early suspension of surgery. Two years later, the patient presented with a pulsatile sound, diminished hearing, and right-sided pain. CT angiography revealed an AVF with three feeding branches and a high-flow fistula involving the superficial temporal artery. Selective angiography and subsequent superselective embolization using PHIL completely occluded the fistula. Follow-up angiography confirmed successful embolization, and the patient reported resolution of symptoms, remaining asymptomatic at 8 months. CONCLUSION: Although AVFs following TMJ arthroscopy are rare, early recognition and appropriate treatment are crucial. Superselective arterial embolization with PHIL represents an effective, minimally invasive treatment for TMJ-associated AVFs. This case highlights the importance of prompt intervention in managing vascular complications following TMJ arthroscopy and demonstrates PHIL's potential as an embolic agent in high-flow fistulas. CLINICAL RELEVANCE: Superselective embolization with PHIL offers a precise, minimally invasive solution for high-flow AVFs post-TMJ arthroscopy, ensuring complete occlusion while minimizing complications. This case underscores PHIL's efficacy as an advanced embolic agent for rare but critical vascular injuries, optimizing patient outcomes.