1Anis Nassif

1Lebanese American University


We would like to present for discussion a rare case of a 9 y old girl of a facial artery to facial vein high flow fistula secondary a hypervascular aneurysmal bone cyst ( ABC ) in the right mandible eroding into the facial artery mimicking an AVM . We embolized the fistula with Onyx 18 liquid embolic prior to surgical resection. This young child is devastated after failing 2 previous surgical resections secondary significant blood loss in the OR.

Material(s) and Method(s):

Using a tri axis approach , we advanced a Sonic microcatherter with 25 mm detachable tip over a Hybrid .08 microwire with a J curve tip into the foot of the facial vein at the level of the fistula and embolized it with 7.5 cc or 5 vials of Onyx 18 with significant decrease in vascularity.

The microcather was pulled out and the tip was detached and left in the liquid embolic.


The fistula was successfully embolized and devascularised in order to allow the surgeons to resect the ABC in the right mandible in this 9 y old girl . She had failed 2 prior surgical attempts secondary high loss of blood in the operating room.


An ABC can erode into the adjacent artery and result in a high flow fistula . Pre surgical embolization is an adequate method to successfully treat and resect the ABC and reconstruct the mandible in this young child.