Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Embolization for treating posttraumatic pseudoaneurysm of the sphenopalatine artery

  • Chun, Jeong Jin (Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine) ;
  • Choi, Chang Yong (Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine) ;
  • Wee, Syeo Young (Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine) ;
  • Song, Woo Jin (Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine) ;
  • Jeong, Hyun Gyo (Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine)
  • Received : 2019.05.17
  • Accepted : 2019.07.29
  • Published : 2019.08.20
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Abstract

Posttraumatic pseudoaneurysms of the sphenopalatine artery are rare. Only a few cases have been reported. We report two cases of hemorrhage due to pseudoaneurysm of the sphenopalatine artery. The hemorrhage was uncontrollable. It required embolization. Two patients visited our hospital for treatment of zygomaticomaxillary complex fracture. At the emergency room, patients presented with massive nasal bleeding which ceased shortly. After reduction of the fracture, patients presented persistent nasopharyngeal bleeding. Under suspicion of intracranial vessel injury, we performed angiography. Angiograms revealed pseudoaneurysms of the sphenopalatine artery. Endovascular embolization was performed, leading to successful hemostasis in both patients. Due to close proximity to pterygoid plates, zygomaticomaxillary complex fracture involving pterygoid plates may cause injury of the sphenopalatine artery. The only presentation of sphenopalatine artery injury is nasopharyngeal bleeding which is common. Based on our clinical experience, although pseudoaneurysm of maxillary artery branch after maxillofacial trauma has a low incidence, suspicion of injury involving deeply located arteries and early imaging via angiogram are recommended to manage recurrent bleeding after facial trauma or surgery.

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References

  1. Hollow P, D'Sa A, McAndrew PG. Life-threatening haemorrhage after elevation of a fractured zygoma. Br J Oral Maxillofac Surg 1999;37:448-50. https://doi.org/10.1054/bjom.1998.0011
  2. Avelar RL, Goelzer JG, Becker OE, de Oliveira RB, Raupp EF, de Magalhaes PS. Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery. J Craniofac Surg 2010;21:1764-8. https://doi.org/10.1097/SCS.0b013e3181f40393
  3. Guyot LL, Kazmierczak CD, Diaz FG. Vascular injury in neurotrauma. Neurol Res 2001;23:291-6. https://doi.org/10.1179/016164101101198442
  4. Foletti JM, Bruneau S, Puech B, Guyot L, Chossegros C. Lifethreatening hemorrhage after zygomatic bone surgery: about 2 posttraumatic cases. Rev Stomatol Chir Maxillofac Chir Orale 2016;117:183-7.
  5. Rogers SN, Patel M, Beirne JC, Nixon TE. Traumatic aneurysm of the maxillary artery: the role of interventional radiology: a report of two cases. Int J Oral Maxillofac Surg 1995;24:336-9. https://doi.org/10.1016/S0901-5027(05)80485-0
  6. Austin RE, Stewart TL, Antonyshyn OM. Intracranial pseudoaneurysm associated with orbitozygomatic complex fracture. J Craniofac Surg 2014;25:1410-2. https://doi.org/10.1097/SCS.0000000000000964
  7. Fan X, Mao Q. Life-threatening oral haemorrhage of a pseudoaneurysm after raising of a fractured zygoma. Br J Oral Maxillofac Surg 2002;40:508-9. https://doi.org/10.1016/S0266435602002450
  8. Nastro Siniscalchi E, Catalfamo L, Pitrone A, Papa R, Fama F, Lo Giudice G, et al. Traumatic pseudoaneurysm of the internal maxillary artery: a rare life-threatening hemorrhage as a complication of maxillofacial fractures. Case Rep Med 2016;2016:9168429.
  9. Alonso N, de Oliveira Bastos E, Massenburg BB. Pseudoaneurysm of the internal maxillary artery: a case report of facial trauma and recurrent bleeding. Int J Surg Case Rep 2016;21:63-6. https://doi.org/10.1016/j.ijscr.2016.02.022
  10. Liu WH, Chen YH, Hsieh CT, Lin EY, Chung TT, Ju DT. Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature. Am J Emerg Med 2008;26:516.
  11. Ho K, Hutter JJ, Eskridge J, Khan U, Boorer CJ, Hopper RA, et al. The management of life-threatening haemorrhage following blunt facial trauma. J Plast Reconstr Aesthet Surg 2006;59:1257-62. https://doi.org/10.1016/j.bjps.2005.12.044
  12. Cohen S, Anastassov GE, Chuang SK. Posttraumatic pseudoaneurysm of the sphenopalatine artery presenting as persistent epistaxis: diagnosis and management. J Trauma 1999;47:396-9. https://doi.org/10.1097/00005373-199908000-00034
  13. Lanigan DT, Hey JH, West RA. Major vascular complications of orthognathic surgery: false aneurysms and arteriovenous fistulas following orthognathic surgery. J Oral Maxillofac Surg 1991;49:571-7. https://doi.org/10.1016/0278-2391(91)90337-L
  14. Khanna S, Dagum AB. A critical review of the literature and an evidence-based approach for life-threatening hemorrhage in maxillofacial surgery. Ann Plast Surg 2012;69:474-8. https://doi.org/10.1097/SAP.0b013e31824a2171