上頷竇之動靜脈畸形：病例報告

An Unusual Arteriovenous Malformation in the Maxillary Sinus: a Case Report

動靜脈畸形 （arteriorvenous malformation, AVM） 為血管畸形的其中一種型態，可發生在身體任何部位，最常發生在腦部 （cerebral AVM），發生在鼻竇內非常罕見。其病因現在仍為不明，女性略多於男性，臨床症狀多為非特異性：如臉面部不適、單側鼻塞、流鼻血等；臨床經驗與病理組織上可能需與血管擴張型息肉作鑑別診斷。根本治療之方式是以手術將病灶完全切除。本院於2005年3月經歷一名57歲男性，術前經電腦斷層影像診斷為兩側慢性鼻竇炎併有上頷竇息肉，而在進行鼻竇內視鏡手術中意外發現一塊已經血栓化的動靜脈畸形於左側上頷竇中。腫瘤經由鼻竇內視鏡手術完全切除，術後核磁共振攝影再次確定無腫瘤殘留及其他位置發生，門診追蹤至今兩年，無復發跡象。

Arteriorvenous malformation (AVM) is a type of the vascular malformation which may present in any tissue of the body. It is more common in the brain (cerebral AVM), while rarely occurring in the nasal sinus. The exact etiology of the disease remains unknown and females are slightly more prone to the disease than males. Clinical presentations are mostly non specific: discomfort of maxillofacial region, unilateral nasal obstruction, epitaxis, etc. Clinically and histopathologically, this disease has to be differentiated from angiectatic polyps. Therapeutic treatment is complete resection. We encountered one 57-year-old man in March 2005, who was diagnosed with bilateral chronic nasosinusitis and preoperative sinus CT reported bilateral chronic rhinosinusitis with left side antral polyp-like lesion. During the endoscopic sinus surgery, we accidentally encountered an isolated thrombosed arteriovenous malformation in the left maxillary sinus. The mass was successfully removed completely and the postoperative head and neck MRI showed no residual tumor and other vascular lesion. He followed up at our out-patient department 2 years postoperatively and there is no sign of recurrence.