What is facial arteriovenous malformation (AVM)?

A facial AVM is a tangle of abnormal blood vessels in the face. Blood vessels involved in a facial AVM include:

• Arteries. They carry blood that’s rich with oxygen from your heart to your cells, tissues and organs.
• Capillaries. They connect small arteries to small veins.
• Veins. They carry blood and waste products back to your heart.

Normally, an artery gives rise to tiny capillaries. Nutrients and oxygen from your blood leave the capillaries to nourish the cells nearby. The capillaries then give rise to a vein which drains blood with wastes and less oxygen back to the heart.

In a facial AVM, however, blood goes from an artery directly into a vein. It’s a short circuit, since it avoids the capillaries. Because of heavy blood flow from the artery, the vein becomes engorged (enlarged) from too much blood. The engorged vein changes the appearance of the face.

What are the signs and symptoms of facial AVM?

The jaw is the most common location for a facial AVM, but it can involve many parts of the face. Facial AVM can cause blood vessels to grow too large, which can lead to:

• This means one side of your face may look different than the other side.
• Replacement of bones, muscles and organs in the face. This means a facial AVM may wear down bones or occupy muscles and organs in the face.
• Dislocation (movement) of normal structures in the face. This can cause changes in the way your face looks (also called disfigurement).
• Lump in the face

What’s the difference between a facial AVM and a brain AVM?

Facial AVMs and brain AVMs are different conditions:

• Facial AVMs are superficial, which means they happen in the skin and soft tissues outside of the skull. Facial AVMs don’t affect the brain. Signs of facial AVMs are easy to see because they create changes in the face.
• Brain AVMs are internal (inside the skull). A brain AVM may not cause any signs or symptoms until it bleeds.

Brain AVMs are more dangerous when they rupture (burst) than are facial AVMs. However, both can be life-threatening. Learn more about the diagnosis and treatment of brain AVMs at Brigham and Women’s Hospital.

What causes facial AVM?

Facial AVM is often congenital (present at birth). The causes of facial AVM are not yet known, though there may be genetic causes. More research is needed on the risk factors linked to facial AVM.

How is facial AVM diagnosed?

Facial AVM is diagnosed with a physical exam and imaging. Your doctor may use one or more of the following imaging methods:

• Computed tomography (CT) This method uses special X-ray equipment to make a series of detailed, cross-sectional images from different angles of your face.
• Magnetic resonance imaging (MRI). This method uses a large magnet and radio waves to look at organs and structures inside the body.
• Ultrasound (also called sonogram). This method uses high-frequency sound waves to make images of the inside of your body.

What is the treatment for facial AVM at Brigham and Women’s Hospital?

There are two treatment options for facial AVM:

1. Careful observation (also called watchful waiting): If you don’t have symptoms, facial AVM may be treated with careful observation instead of surgery. This means your doctor monitors your health closely and you get follow-up medical care as needed if you develop symptoms.
2. Surgery: If you feel pain or other symptoms, or if the facial AVM is growing in size, open surgery may be offered in addition to endovascular embolization. Open surgery is traditional surgery that uses larger incisions (cuts). Endovascular embolization is a minimally invasive treatment where abnormal tissues and blood vessels are treated from inside the vessel. A minimally invasive surgery is a procedure that limits the size and number of incisions. It’s less risky than open surgery. You may also have a shorter hospital stay and recover faster and with less pain. It’s the preferred treatment and standard of care over open surgery. Some patients with facial AVM may have open surgery or a combination of endovascular and open surgery. Open surgery can vary in recovery time and requires consultation with surgeons.

Learn more about facial AVM treatment at Brigham and Women’s Hospital.

Who treats facial AVM at Brigham and Women’s Hospital?

Adults with facial AVM are treated in the Center for Cerebrovascular Diseases. Our specialists who treat facial AVM include:

• Mohammad A. Aziz-Sultan, MD
• Karen Chen, MD

Since facial AVM can involve many different parts of the face, physicians and surgeons from multiple specialties will work together as a team to treat you. Your team of neurosurgeons and interventional neuroradiologists may collaborate with other specialists from Brigham and Women’s Hospital, including:

• Division of Plastic Surgery
• Division of Oral Medicine and Dentistry
• Division of Otolaryngology - Head and Neck Surgery

Contact the Center for Cerebrovascular Diseases

The Center for Cerebrovascular Diseases at Brigham and Women’s Hospital is home to a team of neurosurgeons and interventional neuroradiologists including leaders in the treatment of facial AVMs. Our neurosurgeons are known for their clear communication, compassion, personal care and attention to patients.

To schedule an appointment with a physician in the Center for Cerebrovascular Diseases, please contact our patient coordinator at: (617) 732-6600.

If you are a physician seeking to refer a patient to the Center for Cerebrovascular Diseases, please call (617) 732-6600 or you can access our physicians’ office phone numbers. To contact one of our physicians with a question, patient referral or second opinion, you may also email: BWHNeurosurgery@partners.org.