Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Ruptured pseudoaneurysm of the internal maxillary artery in zygomaticomaxillary fracture: a case report

  • Lim, Soo Yeon (Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine) ;
  • Lee, Hyun Gun (Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine) ;
  • Kim, Kyu Nam (Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Hoon (Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine) ;
  • Oh, Dong Hyun (Department of Radiology, Konyang University Hospital, Konyang University College of Medicine) ;
  • Koh, In Chang (Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine)
  • Received : 2022.03.17
  • Accepted : 2022.04.20
  • Published : 2022.04.20
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Abstract

Post-traumatic pseudoaneurysms of internal maxillary artery are rare, but may be life-threatening. When arterial damage leads to pseudoaneurysm formation, delayed intractable epistaxis can occur. We report our experience with the diagnosis and management of a ruptured internal maxillary arterial pseudoaneurysm that was discovered preoperatively in a patient with a zygomaticomaxillary complex (ZMC) fracture. He presented to the emergency room with epistaxis, which ceased shortly, and sinus hemorrhage was observed with a fracture of the posterior maxillary wall. The patient was scheduled for open reduction and internal fixation (ORIF) of the ZMC fracture. However, immediately before surgery, uncontrolled epistaxis of unknown origin was observed. Angiography indicated a pseudoaneurysm of the posterior superior alveolar artery. Selective endovascular embolization was performed, and hemostasis was achieved. After radiologic intervention, ORIF was successfully implemented without complications. Our case shows that in patients with a posterior maxillary wall fracture, there is a risk of uncontrolled bleeding in the perioperative period that could be caused by pseudoaneurysms, which should be considered even in the absence of typical symptoms.

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References

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