Ruptured pseudoaneurysm of the internal maxillary artery in zygomaticomaxillary fracture: a case report

Abstract

Post-traumatic pseudoaneurysms of internal maxillary artery are rare, but may be life-threatening. When arterial damage leads to pseudoaneurysm formation, delayed intractable epistaxis can occur. We report our experience with the diagnosis and management of a ruptured internal maxillary arterial pseudoaneurysm that was discovered preoperatively in a patient with a zygomaticomaxillary complex (ZMC) fracture. He presented to the emergency room with epistaxis, which ceased shortly, and sinus hemorrhage was observed with a fracture of the posterior maxillary wall. The patient was scheduled for open reduction and internal fixation (ORIF) of the ZMC fracture. However, immediately before surgery, uncontrolled epistaxis of unknown origin was observed. Angiography indicated a pseudoaneurysm of the posterior superior alveolar artery. Selective endovascular embolization was performed, and hemostasis was achieved. After radiologic intervention, ORIF was successfully implemented without complications. Our case shows that in patients with a posterior maxillary wall fracture, there is a risk of uncontrolled bleeding in the perioperative period that could be caused by pseudoaneurysms, which should be considered even in the absence of typical symptoms.

Impacted upper third molar surgical removal leads to pseudoaneurysm: A case report highlighting surgical risks

“…Extracranially, the most common cause is post-traumatic, either by blunt or penetrating trauma. 3,4 Fractures involving the mandibular condyle are especially susceptible, with injury of the maxillary artery either during the initial trauma, or after the surgical reduction. 5 Iatrogenic causes after surgery have also been reported, mainly after orthognathic surgery (bilateral sagittal split osteotomy as well as LeFort I osteotomy), [6][7][8] TMJ surgery or after tumour resection in the head and neck region.…”

“…The majority of head and neck pseudoaneurysms occur intra‐cranially, and occur as a complication of surgical or traumatic injuries, chemoradiotherapy, arteriosclerotic disease and infections. Extra‐cranially, the most common cause is post‐traumatic, either by blunt or penetrating trauma 3,4 . Fractures involving the mandibular condyle are especially susceptible, with injury of the maxillary artery either during the initial trauma, or after the surgical reduction 5 .…”

Traumatic hematoma-based pseudoaneurysm of the superficial temporal artery in a 7-year-old boy: a case report

“…However, in some cases, such as that presented herein, initial CT imaging shows no significant abnormalities. Nevertheless, a small amount of blood clotting can develop into a vi-sually apparent hematoma in weeks or days [1,2]. Patients may visit the hospital several times during the gradual development of a palpable mass, which is eventually diagnosed as a pseudoaneurysm via ultrasonography or enhanced CT.…”

Relationship between midfacial fractures and maxillary sinus pathology

“…These fractures can be caused by motor vehicle accidents, domestic disputes, falls, industrial accidents, or assaults with or without a weapon [ 1 - 5 ]. When a midfacial fracture is accompanied by a maxillary sinus fracture, potential complications may include orbital muscle entrapment, orbital cellulitis, orbital abscess, enophthalmos, hypophthalmos, sinusitis, sinus mucocele, pseudoaneurysm, oromaxillary fistula, dental malocclusion, epistaxis, facial asymmetry, chronic facial pain, pressure sensitivity, and infraorbital nerve paresthesia [ 2 , 3 , 6 , 7 ].…”