Massive Hemorrhage in Facial Fracture Patients: Definition, Incidence, and Management

Abstract

Massive hemorrhage from facial fractures is an underrecognized and inconsistently managed phenomenon. Although low in incidence, its timely recognition and better management may reduce the high mortality rate in this group of patients.

Maxillary Artery Pseudoaneurysm After Le Fort I Osteotomy

“…11 Owing to the extensive anastomotic network and collateral circulation within the head and neck, the failure rate of surgical ligation has led the use of selective angioembolization for acute control of maxillofacial bleeding. 4,5,7,9,10,12 Angiographic embolization was described in the 1930s, and its first successful use for embolization of the maxillary artery as a treatment of refractory nasal hemorrhage was reported by Sokoloff et al 13 in 1974. This modality has been shown to be both safe and effective for the treatment of head and neck hemorrhage.…”

“…The initial management of these patients should focus on airway stabilization, bleeding control, and resuscitation per the Advanced Trauma Life Support protocol. 9,10 Airway patency in patients with extensive maxillofacial hemorrhage is tenuous whether the bleeding is secondary to trauma, iatrogenic injury, or congenital vascular malformation. Excessive bleeding can cause significant distress, making it difficult for these patients to protect their airway.…”

“…Mental obtundation from associated intracranial injury, diffuse soft tissue edema, and associated facial fractures further compromise airway protection in the trauma population. 9 Initial attempts to control bleeding should be initiated once the airway is controlled.…”

Hemorragia incoercible por trauma maxilofacial: experiencia del Hospital del Trabajador

“…En los 10 años de nuestro estudio, no se identifi có ningún caso de muerte atribuible en mayor o menor medida a una hemorragia por traumatismo maxilofacial. Así como lo reporta Dean et al en su estudio 2 , todos los pacientes que presentaron sangramiento por trauma facial sin otras lesiones sobrevivieron, en cambio, la mitad de los pacientes con trauma facial asociado a otro trauma (politraumatizado) fallecieron por causas no siempre relacionadas a la hemorragia facial. Por otro lado, el colegio americano de cirujanos defi ne hemorragia masiva (tipo III) como toda aquella en la que se ha perdido entre un 30 a un 40% del volumen sanguíneo, lo que se traduce en hipotensión, taquicardia sobre 140, taquipnea, oliguria, ansiedad y confusión 6 .…”

“…Sin embargo, si se consideran todos los tipos de trauma facial, esta incidencia es mucho menor. Dean et al 2 , reportan su experiencia de 20 años en hemorragia masiva secundaria a trauma facial, y determinaron una incidencia de 0,33%. Ardekian et al 4 , muestran una gran variabilidad en la incidencia reportada de esta patología que va desde el 0 al 11% de los traumas faciales.…”