Penetrating foreign body in the masticator space with injury to the internal maxillary artery: a surgical challenge

Abstract

INTRODUCTION Foreign bodies (FBs) in the masticator space (MS) are a unique problem because of the difficulty of accessing this deep compartment within the head and neck. In addition, MS contents include critical structures such as the internal maxillary artery (IMA) and mandibular nerve. CASE HISTORY A 39-year-old tradesman was involved in a construction accident whereby a metallic projectile from a machinery drill penetrated his left cheek. Computed tomography revealed a metallic object of dimension 1.9 Â1.2 cm within the MS, with concomitant fracture of left maxillary anterior and lateral walls. Surgery was indicated in view of constant pain and swelling. The FB was removed through the cheek laceration with the aid of an X-ray image intensifier. Persistent significant bleeding was observed within the wound cavity after FB removal that could not be arrested despite attempts at haemostasis with adrenaline packing and oxidised cellulose polymers. Urgent selective left external carotid angiography showed breach of a distal branch of the left internal maxillary artery with contrast extravasation. Embolisation of this branch was undertaken successfully with a liquid agent. CONCLUSIONS This is the first time a FB within the MS with injury to the internal maxillary artery has been described.

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“…Infratemporal fossa contains internal maxillary artery, pterygoid venous plexus of veins. Wulkan et al [3] reported complications associated with extraction of such foreign bodies due to internal maxillary artery injury, which can be surgically uncontrollable and potentially fatal [4]. Some delayed complications have also been reported like aneurysm [5] and erosion of the vessel wall [6].…”

“…But these approaches are rarely required for foreign bodies. In the past infratemporal fossa foreign bodies have been explored using pre auricular approach [7], intraoral approach [8], endoscopic intraoral approach [4], transmaxillary endoscopic approach [9] We explored the foreign body using infraorbital horizontal incision. As the periorbita was being raised from the orbital floor foreign body was palpated and confirmed using 0-degree endoscope and was pulled out under vision without any post operative complications.…”

Old Penetrating Orbito-Infratemporal Wooden Foreign Body – “An Escape”

“…Infratemporal fossa contains internal maxillary artery, pterygoid venous plexus of veins. Wulkan et al [3] reported complications associated with extraction of such foreign bodies due to internal maxillary artery injury, which can be surgically uncontrollable and potentially fatal [4]. Some delayed complications have also been reported like aneurysm [5] and erosion of the vessel wall [6].…”