Facial Vascular Malformations/ Venous Vascular Malformations

What is a facial vascular malformation?

Facial vascular malformations are abnormally developed blood vessels which can occur anywhere in the head and neck. They are usually present at birth, but can enlarge over time, and patients might not notice them until many years later. They are usually abnormal veins – these are called venous vascular malformations, or facial VVMs. Sometimes they also involve arteries – these are called arteriovenous malformations, or facial AVMs. Except for very rare familial conditions, they are usually not inherited. There is nothing you can do to avoid or prevent getting one.

Face AVM

Facial Arteriovenous Malformations (AVMs)

Face VVM

Facial Venous Vascular Malformations (VVMs)

What are the symptoms?

The main complaint is cosmetic, a mass on the face which is soft and sometimes blue in color – you might not like how it looks, and want it to be treated.  They only very rarely bleed, if they are very near the skin or on the surface of the tongue. Bleeding is easily stopped by applying local pressure. More commonly, they present with intermittent swelling, which is sometimes painful. They can cause problems with swallowing, if they are on the tongue or throat, or problems breathing – if they are located in your airway.

How are they diagnosed?

A CT scan for a facial venous malformation will demonstrate a soft tissue mass and an Ultrasound will show it’s vascular nature.  However the best way look at a venous malformation is an MRI scan.  This helps to make the diagnosis and get a good look at where in the body the lesion is, and what other tissues are around it. Often, there can be a larger component to the vascular malformation under the skin, and an MRI scan will help us to see this.

Sometimes, if we think there is an artery involved, we will order an angiogram. This is an out-patient test, performed under sedation, where we place tiny tubes named catheters into the blood vessels leading to the AVM. We can then inject x-ray contrast/x-ray dye to see the lesion better.

How are facial vascular malformations treated?

This depends on what type of vascular malformation it is:

Venous Vascular Malformation (VVM)

This is the most common type. These can often be treated by injecting a substance that is toxic to the veins. This irritates them, scars them, and causes them to get smaller. This procedure is also known as ‘sclerotherapy’. The substance we use to do this is called Bleomycin. This is a drug which is used in much higher concentrations to treat certain cancers. We use very low doses of it. This is performed as a day-case procedure, using sedation. We use very small needles to puncture the venous malformation, using x-rays or ultrasound to help identify it. We then inject small amounts of bleomycin into as many areas of the venous malformation as we can. You can usually go home an hour or so after the procedure. This treatment is often repeated several times, spaced out over a few weeks each, in order to treat as much of the abnormal veins as possible. Occasionally the venous malformation can swell and even temporarily get slightly bigger as a result of treatment. This usually resolves over time.  Sometimes the treatment causes the venous malformation to completely disappear, but usually they just get smaller. Treatment usually helps to reduce swelling episodes and related pain. Sometimes they will vanish but leave a hard “scar” of tissue under the skin, where they used to be. It varies from person to person. What we often recommend is that you undergo a few sessions of sclerotherapy. After that we will reassess things, and may recommend more treatment if it is having good effect.

Face VVM injection

Percutaneous Embolisation (sclerotherapy) of facial VVM

Face AVM Embolism

Transarterial Embolisation facial AVM

Arteriovenous Malformation (AVM)

This type is less common, and treatment is more complicated. We usually see these patients along with a plastic surgeon with a special interest in treating these lesions. We can often treat them together in a combined approach. This means a multi-stage procedure, performed under general anaesthetic. The first step is treating the AVM from inside the blood vessels. By inserting small tubes/catheters into the blood vessels at the groin, we can then navigate these to the blood vessels affected. We can than inject a special substance called ‘Onyx’ into the blood vessels feeding the AVM. This is a special type of liquid that then hardens and closes off the blood vessels. This hard substance remains under the skin or deep in the soft-tissues. That is why the next step, which happens a few days/weeks later, involves the plastic surgeon removing the AVM. Again, this type of treatment is not as common as the other type, and we will discuss this in detail with you if we are recommending it.