Introduction Facial AVMs are associated both with risk of hemorrhage and considerable psychosocial as well as cosmetic distress. Head and neck AVMs are the second most common outside of the brain, but despite being a richly-vascularized area, giant and diffuse lesions of the magnitude reported are rare and typically evolve from iatrogenesis.
Case presentation A 32 year-old male presented with a pulsatile facial mass which had treated unsuccessfully at numerous outside intuitions. Imaging revealed a diffuse facial AVM with extensive bilateral supply, and a ligated left external carotid artery. Though incurable, endovascular treatment was required frequently for hemorrhagic events and palliation were delivered via the contralateral supply due ligation of a direct route to the nidus.
Discussion We report a particularly complicated case of giant facial AVM which initially imparted significant psychosocial morbidity, but as a result of proximal ligation and improper embolization grew into a tremendous lesion the size and extent of which has not been reported previously. It remains absolutely essential that no attempt at palliation or cure be made that cannot directly target the nidus of an AVM, and this ever the more crucial in rich-supplied areas such as the face. Endovascular embolizations remains the first and often only option during when emergent therapy.
Disclosures A. Dmytriw: None. J. Song: None. S. Power: None. R. Agid: None.
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