Recognixing and Managing Laryngeal Pathology A Patient with Massive Oral-Facial Venous Malformation zyxwvutsrqponmlkjihgfedcbaZYXWVUT James T. Roberts, MD,* John Pile-Spellman, MD,? Michael Joseph, MD,$ Edward Glinski, MD,§ John Chin, MD,I( Lofti Hacein-Bey, MD# Departments of Anaesthesia, Radiology, and Otology and Laryngology, Harvard Medical School, Massachusetts Genera1 Hospital, and Massachusetts Eye and Ear Infìrmary, Boston, MA. *Associate Anesthetist, Massachusetts Genera1 Hospital, and Assist- ant Professor of Anaesthesia, Harvard Medical School, Boston, MA tAssistant Radiologist, Massachusetts Genera1 Hospita], and Assist- ant Professor of Radiology, Harvard Medical School, Boston, MA $.Assistant Surgeon in Otolaryngology, Massachusetts Eye and Ear- Intìrmary, and Assistant Professor of Otology and Laryngology, Harvard Medical School, Boston, MA 5Surgeon in Otolaryngology, Massachusetts Eye and Ear Infirmary, and Clinical Instructor in Otology and Laryngology, Harvard Med- ical School, Boston, MA IIAssistant in Radiology, Massachusetts General Hospital, and In- structor in Radiology, Harvard Medical School, Boston, MA #Clinical Fellow in Radiology, Massachusetts General Hospital, and Clinical Fellow in Radiology, Harvard Medical School, Boston, MA Address reprint requests to Dr. Roherts at the Department of Anes- thesia, Massachusetts Genera1 Hospital, 32 Fruit Street, Boston, Massachusetts 02 114, USA Received for publication August 13, 1990; revised manuscript ac- cepted for publication October 31, 1990. 0 3991 Butterworth-Heinemann 76 J. Uin. Anesth., vol. Z1, JanuaryiFebruary 1991 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA W hile malformations of the upper airway are rare, they pre- sent challenging management problems and have a poten- tially devastating impact during anesthesia. This case report describes the management of a patient with u massiue supru- glottic uenous malformation as he underwent transvenous embolization. Keywords: zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONM Vascular diseases; airway obstruction; embolization, therapeutic; anesthesia. zyxwvutsrqponmlkjihgfe Case Report A 29-year-old male was referred for transvenous em- bolization of a venous malformation of his left check, mandible, infratemporal fossa, tongue, and orophar- ynx (Fi<gure 1). The lesion was present since birth and multiple plastic surgical procedures to contour his lip had been performed. Three years prior to admission, an infected third molar was removed under genera1 anesthesia after an uneventful awake oral endotra- cheal intubation. During the 6 months prior to ad- mission, he developed a seizure disorder, which was