Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Delayed rupture of a posttraumatic retromaxillary pseudoaneurysm causing massive bleeding: a case report

  • Hwang, Jae Ha (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Kim, Woo Hyeong (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Choi, Jun Ho (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Kim, Kwang Seog (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Lee, Sam Yong (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School)
  • Received : 2021.05.21
  • Accepted : 2021.06.14
  • Published : 2021.06.20
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Abstract

Posttraumatic pseudoaneurysm of the face is caused by blunt, penetrating, or surgical trauma. Although its incidence is low, pseudoaneurysm rupture can cause a life-threatening, massive hemorrhage. A 48-year-old man visited our emergency center due to a fall-down accident. Three-dimensional computed tomography (CT) showed a comminuted zygomaticomaxillary complex fracture of the left face. After open reduction and internal fixation, the surgical wound healed without any complications. However, the patient was readmitted 10 days after surgery due to pus-like discharge from the wound. Contrast-enhanced CT to find the abscess unexpectedly revealed a pseudoaneurysm in the left retromaxillary area. Massive oral bleeding occurred on the night of re-hospitalization and emergency surgery was done. The bleeding site was identified as a pseudo-aneurysmal rupture of the posterior superior alveolar artery in the retromaxillary area. Hemostasis was achieved by packing Vaseline gauze in the maxillary sinus using an endoscope. Delayed rupture and massive bleeding of posttraumatic retromaxillary pseudoaneurysm after a zygomaticomaxillary fracture is a low-probability, but high-impact event. Therefore, additional contrast-enhanced CT should be considered to evaluate the possibility of a posttraumatic pseudoaneurysm in cases of severe comminuted zygomaticomaxillary fracture.

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References

  1. Conner WC 3rd, Rohrich RJ, Pollock RA. Traumatic aneurysms of the face and temple: a patient report and literature review, 1644 to 1998. Ann Plast Surg 1998;41:321-6. https://doi.org/10.1097/00000637-199809000-00019
  2. 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
  3. Dudaryk R, Horn DB, Green JM 3rd. Facial artery pseudoaneurysm: challenges of airway management. Anesth Prog 2018;65:52-5. https://doi.org/10.2344/anpr-65-02-09
  4. 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.
  5. Feliciano DV, Cruse PA, Burch JM, Bitondo CG. Delayed diagnosis of arterial injuries. Am J Surg 1987;154:579-84. https://doi.org/10.1016/0002-9610(87)90220-0
  6. Hertzer NR. Extracranial carotid aneurysms: a new look at an old problem. J Vasc Surg 2000;31:823-5. https://doi.org/10.1067/mva.2000.105675
  7. Goddard AJ, Lenthall RK, Bradley PJ. Endovascular management of infected carotid artery pseudoaneurysm complicating pharyngolaryngectomy: complete occlusion followed by early recurrence and rebleeding. J Laryngol Otol 2004;118:991-5. https://doi.org/10.1258/0022215042790574
  8. Park JK, Kim SW. Zygomaticomaxillary complex fracture after two-jaw surgery. Arch Craniofac Surg 2020;21:301-4. https://doi.org/10.7181/acfs.2020.00276
  9. Lee SY, Kim SH, Hwang JH, Kim KS. Sensory recovery after infraorbital nerve avulsion injury. Arch Craniofac Surg 2020;21:244-8. https://doi.org/10.7181/acfs.2020.00290
  10. Lee H, Kim KS, Choi JH, Hwang JH, Lee SY. Trauma severity and mandibular fracture patterns in a regional trauma center. Arch Craniofac Surg 2020;21:294-300. https://doi.org/10.7181/acfs.2020.00556
  11. Hassan F, Younes A, Rifai M. Endovascular embolization of post-tonsillectomy pseudoaneurysm: a single-center case series. Cardiovasc Intervent Radiol 2019;42:528-33. https://doi.org/10.1007/s00270-018-2131-9
  12. Willems PW, Farb RI, Agid R. Endovascular treatment of epistaxis. AJNR Am J Neuroradiol 2009;30:1637-45. https://doi.org/10.3174/ajnr.A1607
  13. Ryu JY, Lee JH, Lee JS, Lee JW, Lee SJ, Lee JM, et al. Combined treatment of surgery and sclerotherapy for sinus pericranii. Arch Craniofac Surg 2020;21:109-13. https://doi.org/10.7181/acfs.2019.00521