Intraparotid Arterial Aneurysm Treated with Embolization Followed by Surgical Resection

Abstract

We describe the case of a 41-year-old woman who presented to a local facial plastic surgeon for evaluation of a cosmetic defect of the cheek of 1 month's duration. When imaging revealed the presence of a vascular mass, the patient was referred to us. Further imaging identified the mass as an intraparotid external carotid artery aneurysm. The decision was then made to treat the patient with embolization of the lesion followed by surgical resection the next day. During the resection, the lateral-most aspect of the aneurysm was found to be adherent to and splaying the facial nerve. The embolized mass and the surrounding fascial layer were removed, and the branches of the facial nerve were retracted superiorly and inferiorly. Dissection proceeded around the aneurysm in this plane. Blood loss during the procedure was minimal. On postoperative day 1, the patient exhibited minimal lower facial asymmetry. In this case, performing embolization prior to surgical resection appeared to be a prudent and efficacious strategy. The preoperative embolization greatly reduced the risk of damage to the facial nerve.

Seltene Erkrankungen der Speicheldrüsen und des Nervus Facialis

“…Imaging by means of sonography or ultrasound reveals an inconspicuous gland displaced externally, mostly caused by a medially located mass. In the literature, case reports of aneurysms and pseudo-aneurysms of the internal and external carotid arteries and their branches are described that become apparent due to a unilateral swelling in the jaw angle 162 164 165 166 . Interestingly, also 2 cases have been reported where aneurysm of the superficial temporal artery after parotidectomy has developed 167 168 .…”

“…In der Literatur werden Fallberichte von Aneurysmen und Pseudoaneurysmen der A. carotis interna oder A. carotis externa bzw. ihrer Äste beschrieben, die durch eine einseitige Schwellung im Kieferwinkel aufgefallen sind 162 164 165 166 . Interessanterweise wurden auch 2 Fälle beschrieben, in denen ein Aneurysma der A. temporalis superficials nach einer Parotidektomie entstanden ist 167 168 .…”

Pseudoaneurysm of the facial artery territory in an odontogenic infection setting

“…A true aneurysm retains all three layers of the blood vessels: intima, media, and adventitia. They are frequently associated with atherosclerosis, but can result from arteritis, infection, or fibromuscular dysplasia [1,2]. A false aneurysm or pseudoaneurysm results from vessel wall disruption and extravasation of blood into the surrounding tissue, until the pressure in the hematoma exceeds the arterial pressure, leading to tamponade and clot formation [3,4].…”