PubMed · 4592569
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S L Trokel. 1974. The orbit.. https://doi.org/10.1001/archopht.1974.03900060231016
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Diagnosis relies first on clinical evaluation of the patients. Subsequently, modern diagnostic imaging techniques, such as CT scan, MRI and Echo-Doppler, confirm the clinical approach and define the type of vascular anomaly. Angiographic analysis is not performed for all cases: indications are carefully thought out.
Temporo-masseterine vascular malformations are mature capillarovenous malformations. Being congenital lesions, they are present at birth and progress throughout life, particularly before adolescence. The clinical diagnosis rests on the finding that the malformation swells when the patient is in supine position. Its extent is determined by MRI. Treatment is radiosurgical and always begins with one or several embolizations using Ethibloc. Surgical resection, which is exceptionally complete, may be performed to make the face symmetrical.
Arteriovenous malformations (AVM) are the most dangerous of vascular malformations, being haemodynamically active. These malformations proceed in two phases: a phase of quiescence which may last throughout life, and an unpredictable phase of activity sometimes triggered by a trauma or by hormonal variations (puberty, pregnancy, oral contraceptives). Treatment must be careful usually limited, and considered in the phase of activity. A multidisciplinary consensus is necessary.