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BackgroundSevere bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce.Patients and methodsPubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories.Results and conclusionsBased on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.

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Abstract. Nanovesicles that are pinched off from biological membranes in the final stage of budding constitute a cell-cell communication system. Recent studies indicate that in vivo they are involved in blood clot formation and in cancer progression. The bud is connected to the mother membrane by a thin neck so it dwells close to the mother membrane. Using the electron microscopy we have observed in blood cells that adhesion between the membrane of the bud and of the mother cell in the vicinity of the neck took place and prevented the bud to pinch off from the mother vesicle. The same effect was observed in giant phospholipid vesicles (GPVs) due to attractive interaction between the bud and the mother vesicle mediated by the plasma protein beta-2-glycoprotein I. The stability of the neck is important for this process. By using Fourier method we analyzed thermal fluctuations of a GPV while a protrusion composed of beads connected by thin necks was spontaneously integrated into the mother GPV. Stepwise change of Fourier coefficients indicates an increased stability of necks which contributes to the retention of buds by the mother membrane and promotes anticoagulant and anti-metastatic mechanism by suppression of nanovesiculation.