Aneurysm of the distal facial artery from a penetrating oral prosthesis

Abstract

We report a 94-year-old male who died of pneumonia. During the routine dissection of the head and neck for a gross anatomy course at our institution a mass was noted in the region of the right cheek. Macroscopic and microscopic observation of this mass revealed an aneurysm of the facial artery. A traumatic defect was noted at the apex of the aneurysmal wall related to an intraoral prosthetic clasp that had penetrated the buccinator muscle. Traumatic aneurysms of the face have been caused by blunt trauma to the jaw with or without fracture, surgical manipulation around the teeth and jaw, and following missile injury. Some have described compression of neighboring structures such as cranial nerves and other blood vessels with resultant compromise. We believe our case to be the first report of a facial artery aneurysm in a cadaver and we are unaware of other reports from the literature describing the production of a facial artery aneurysm from a puncture of an intraoral prosthesis through the medially placed buccinator muscle. Although seemingly rare, health care professionals should make efforts to ensure that oral prostheses do not develop sharp or irregular edges that could potentially perforate the lateral oral cavity with potential perforation of the overlying vasculature.

The complete anatomy of the transverse facial artery: a computed tomography angiography analysis

“…Additionally, Tubbs et al conducted a study reporting a remarkable specimen of a large TFA compensating for the complete absence of the corresponding FA on the left side, though it was a unilateral abnormality [14]. In the present study, the FA dominated over the TFA in all of the cases.…”

Uncommon complication of facial fractures

“…Those that have been reported occurred after reduction of facial fractures, such as panfacial fractiures 6 , post dental extraction 5 , poorly made prostheses 11 and orthognathic surgery. Most occurred after maxillary surgery, with involvement of the maxillary artery 1 or sphenopalatine artery 9 , but pseudoaneurysms after mandibular osteotomies 8 also have been reported.…”

True aneurysm of the facial artery

“…The most frequently affected vessels are the superficial temporal artery 2 and the facial artery 3 . The vast majority of these cases describe false aneurysms that have an associated traumatic aetiology, including blunt trauma 4 and penetrating trauma caused by glass, 5 gunshots 6 and intra-oral prostheses 7 . Injury to the vessel wall gives rise to a local haematoma which expands until the resistance of surrounding soft tissues equals the systolic arterial pressure.…”