| Background:Fast-flow vascular lesions of maxillofacial regions are a kind of complicated and dangerous pathological changes originating from or contain arteries[1],treatment of them often varies from disease to disease.In the surgical procedure,the large amount of blood loss and the poor surgical field may cause side injury or other problems,even be life-threatening.We used Color Doppler Ultrasound（CDUS）combined with Three-dimensional Computed Tomography Angiography（3D-CTA）to diagnose and classify36 patients with maxillofacial fast-flow vascular diseases who were admitted to our department from January 2018 to December 2022.3D-CTA can display the location,type and blood supply of the lesions,while CDUS has unique advantages in identifying some special lesions（such as the colorful images of orificium fistulaes and the"Yin-yang sign"of pseudoaneurysms）,then project and mark them on the body surface,which greatly facilitates surgical procedure.This cost-effective,non-invasive combination has significant clinical application value.Objective:Through different types of clinical cases,this paper will discuss and summarize the various auxiliary functions of the combination of CDUS and 3D-CTA in the diagnosis and treatment of different types of maxillofacial fast-flow vascular diseases,and provide an empirical reference for the diagnosis and treatment of such diseases.Methods:From January,2018 to December,2022,36 patients（16 males and 20 females）with maxillofacial fast-flow vascular diseases in our department underwent both CDUS and 3D-CTA examination,including 4 cases of pseudoaneurysms（PSA）of the superficial temporal artery or its branches,10 cases of arteriovenous fistulas（AVFs）,9 cases of hemangiomas and 13 cases of arteriovenous malformations（AVMs）.We collected imaging and photos of the patients,summarized the types of them,described the diagnosis and treatment process of different types of lesions,and made a"Diagnosis and treatment flow chart of maxillofacial fast-flow vascular diseases"to sum up our experience.Results:There were 36 patients in our research totally,of which 4 cases were pseudoaneurysms of superficial temporal artery or its branches（3 of them appeared immediately after trauma）,all lesions regressed spontaneously after pressure dressing;10 cases of AVFs were all fed by superficial temporal arteries,the orificium fistulaes and tortuous diseased arteries were excised after the ligation of the superficial temporal arteries.As to the 9 cases of hemangiomas that contains arteriovenous fistulas,7 of them were resected after the ligation of the feeding artery（superficial temporal artery）,direct resection was performed in 2 cases due to their deep feeding arteries which were difficult to ligate;in 13 cases of AVMs,1 case was directly resected,7 cases were resected after DSA embolization,and for the 5 patients whose lesions were large that the wounds after resection might be difficult to close,they received expander implantation firstly,DSA embolization was performed several months later,followed by lesion resection and flap transfer in 1 to 2 weeks.None of the patients received intraoperative blood transfusion,all of them were followed up for 9 to 24 months without recurrence.Conclusions:CDUS combined with 3D-CTA can provide comprehensive guidance for the diagnosis and treatment of maxillofacial fast-flow vascular diseases and have significant clinical application value.For different types of maxillofacial fast-flow vascular diseases,personalized treatment programs should be designed according to the lesion types and blood supply conditions,so as to reduce the difficulty of surgery and the recurrence rate. |
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