Management of Late Post-traumatic Facial Artery Pseudoaneurysmal Cyst: Review of Literature

Abstract

Pseudoaneurysms of the branches of the external carotid artery as a result of trauma are rare in oral and maxillofacial surgery practice. The most affected branches are the superficial temporal artery, internal maxillary artery and distal part of facial artery, usually where they pass over the bone. Very few cases of facial artery pseudoaneurysms of proximal parts (from external carotid artery up to the lower border of the mandible) are reported in the literature. We present a review of literature for management of late post-traumatic pseudoaneurysmal cyst and a case report involving proximal part of facial artery in the submandibular region following open reduction and rigid fixation of the condylar fracture in a 25-year-old male. To our knowledge this is the fourth reported case of proximal facial artery pseudoaneurysm.

The Presentation and Management of Facial Artery Pseudoaneurysm: A Review of the Literature

“…Aneurysms are classified as true, false, or dissecting. True aneurysm is a dilation of all the three layers of the intact vessel wall ( 1 ). False aneurysm or pseudoaneurysm occurs when blood leaks through an injured blood vessel into the surrounding tissues with a persistent communication or connection between them ( 1 , 2 ).…”

“…Incomplete tear of the involved vessel wall causes blood to flow into the surrounding tissue resulting in tamponade and clot formation ( 1 ). Hemorrhage persists until the pressure in the periarterial zone equals the mean arterial pressure ( 4 ).…”

“…Pseudoaneurysm is a rare vascular complication of trauma, causing an incomplete tear of the vessel wall ( 1 ). The common presentation is a painless pulsatile swelling usually associated with a palpable thrill and an audible bruit ( 2 ).…”

Pseudoaneurysm following Endoscopic-Assisted Repair of Subcondylar Fracture

“…Reports of pseudoaneurysm following ORIF of mandible fractures are more limited, and there are no prior reports of a pseudoaneurysm as a result of endoscopic-assisted ORIF as described here. Shetty et al2 presented a case of large postoperative pseudoaneurysms of the facial artery requiring treatment with sclerotherapy. The patient discussed in their review suffered from a facial artery pseudoaneurysm after traditional ORIF of a condylar fracture.…”

Craniofacial Trauma and Vascular Injury

“…For example, pseudoaneurysms may present days, weeks, or even years following a traumatic craniofacial incident. 48 These patients are at greatest risk of spontaneous, life-threatening bleeding, requiring surgical intervention. 5,47 Pseudoaneurysms should be on the differential during long-term follow-up in trauma patients and should not be confused for lipomas or cysts.…”