Traumatic Pseudoaneurysm: A Life-Threatening Complication After Surgical Extraction of Impacted Maxillary Third Molar

Abstract

Pseudoaneurysms are rare lesions secondary to blunt or penetrating trauma, temporomandibular joint surgery, or orthognathic surgery. They are usually produced by arterial breach leading to extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. This sac gradually expands and can be damaged. Nonsurgical interventions are the treatment of choice for pseudoaneurysms. In the case reported here, emergent endovascular injection of acrylic glue was successful in the treatment of a pseudoaneurysm from a branch of the internal maxillary artery secondary to surgical extraction of impacted maxillary third molar.

An Unusual Presentation of a Neck Mass – Traumatic Pseudoaneurysm Following Third Molar Surgery: A Case Report

“…3,[6][7][8][9][10]14,15 When there is clinical concern for the occurrence of a TPA, a CTA remains the preferred diagnostic modality for initial evaluation. 11 However, when a CTA cannot be obtained, the utilization of ultrasonography and color Doppler can also verify a pseudoaneurysm with the visualization of bidirectional blood flow as shown in this case.…”

“…Acute complications associated with endovascular treatment can include facial palsy, stroke, or central retinal artery occlusion due to thromboembolic events. 11 Small TSAs may be saturated with liquid embolic to prevent retrograde filling. However, the same technique is impractical for large TPA as the embolic will harden and result in a palpable mass.…”

“…Traumatic pseudoaneurysm (TPA) formation is an extremely rare complication which has been reported in the literature as a potential sequela following tooth extraction. [3][4][5][6][7][8][9][10][11] In the maxillofacial region, TPA is most often associated with penetrating trauma, condylar fractures, and orthognathic surgery and involves the branches of the internal maxillary artery. 3,4 TPA occurs when there is disruption in the vascular endothelium followed by blood extravasation into the adventitia or adjacent soft tissue.…”

Selective transarterial embolization for arterial hemorrhage after upper third molar extraction: illustrative cases

“…Endovascular embolization has been used for the hemostasis of significant bleeding after third molar extraction; 2 however, only sporadic case reports have been published in the literature. 3–7 …”