Cauterización transoral de la arteria maxilar interna en la fosa infratemporal: informe de un caso / Transoral cauterization of the internal maxillary artery in the infratemporal fossa: case report

Se describe el caso clínico de una paciente de 84 años que tuvo epistaxis recidivante por padecer enfermedad de Rendu-Osler-Weber. Tuvo antecedentes de diversos tratamientos quirúrgicos que incluyeron el cierre de la fosa nasal izquierda (operación de Young). Por la persistencia de epistaxis izquierda se indicó una angiografía y embolización. Esta última no se hizo porque se diagnosticaron anastomosis entre el sistema carotídeo externo y el interno. Se realizó un abordaje intraoral paramaxilar asistido con endoscopios para cauterizar la arteria maxilar interna en la fosa infratemporal y un abordaje externo para cauterizar la arteria etmoidal anterior solucionando la epistaxis. (AU)

The clinical case of an 84-year-old patient who had recurrent epistaxis due to Rendu-Osler- Weber disease is described. She had a history of various surgical treatments including closure of the left nostril (Young's operation).Due to the persistence of left epistaxis, angiography and embolization were indicated. The latter was not done because anastomosis between the external and internal carotid system was diagnosed. An intraoral paramaxillary approach assisted with endoscopes was performed to cauterize the internal maxillary artery in the infratemporal fossa and an external approach to cauterize the anterior ethmoidal artery solving the epistaxis. (AU)

Traumatic pseudoaneurysms of external carotid artery branch: Case series and treatment considerations / 中华创伤杂志(英文版)

PURPOSE@#To explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.@*METHODS@#Eleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.@*RESULTS@#Complete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5-2.0 years without recurrence of nosebleed and scalp lump.@*CONCLUSION@#For patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.

Treatment of Pseudoaneurysm of Internal Maxillary Artery Resulting from Needle Injury / 대한신경손상학회지

Pseudoaneurysm of internal maxillary artery (IMA) after trauma is rare, and most cases reported are caused by maxilla-facial blunt trauma. Pseudoaneurysm is discontinuity in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space producing pulsatile hematoma rapidly. A 44-years-old woman presented with a pulsatile swelling and pain in the left parotid region. She underwent the masticatory muscle reduction using needle injection in dentistry 1 month ago. The left facial pulsatile swelling developed after the procedure immediately and uncontrolled bleeding occurred on the day of visit to our institution. We performed emergency angiography and diagnosed pseudoaneurysm of left IMA. We treated by embolization with Histoacryl Glue through left IMA. IMA total occlusion was confirmed and symptoms improved. Pseudoaneurysm following blunt trauma of the face have been reported but are few. Furthermore, there is no report of IMA pseudoaneurysm due to direct injury by needle. Recently, many cosmetic surgery procedures using injection techniques have been performed, and it is necessary to pay attention to the direct vessel injury by the needle. And endovascular therapies can give early recovery with minimal morbidity and avoids injury to the facial nerve and its branches.

Clinical study of the removal of infratemporal fossa and pterygopalatine fossa foreign bodies using a trans-oral approach / 口腔疾病防治

Objective @#To summarize the clinical experience of removing infratemporal fossa and pterygopalatine fossa foreign bodies via a trans-oral approach. @* Methods@#The clinical data of 9 patients with foreign bodies in the infratemporal fossa and pterygopalatine fossa hospitalized from March 2008 to June 2017 were analyzed retrospectively. Among these cases, 4 were flying injuries, 2 were falling injuries, 2 were traffic injuries and 1 was an iatrogenic syringe injury. Foreign bodies were divided into the following categories: 3 cases of wood from branches, 3 cases of iron filings, 2 cases of broken glass, and one case of a broken syringe needle. Before surgery, all subjects underwent spiral CT three-dimensional reconstruction and CT angiography examinations. After accurately determining the relationship between the foreign body and the internal and external carotid arteries and their branches, patients underwent an operation under general anesthesia to remove the foreign body via a trans-oral approach. In addition, patients participated in mouth opening training for one week. Then, patients were followed for 1 to 6 months. Foreign bodies were removed completely in all 9 patients.@*Results@#Foreign bodies were independently located in the pterygopalatine fossa in 2 cases and in the in fratemporal fossa in 3 cases. There were 4 cases of foreign bodies located in both the infratemporal fossa and the pterygopalatine fossa. All 9 patients had the foreign bodies completely removed and were discharged one week after surgery. They were followed for 1 to 6 months. Their mouth opening and occlusion were normal, without any complications.@*Conclusion @#Spiral CT, 3D reconstruction and CT angiography examinations are necessary and important for accurate pre-operation positioning. It is feasible to remove foreign bodies in the infratemporal fossa and pterygopalatine fossa via a trans-oral approach.

Recurrent epistaxis from a post-traumatic infraorbital artery pseudoaneurysm

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a rare case of post-traumatic recurrent epistaxis in an elderly woman.<br /><strong>METHODS:</strong><br />  <strong>Design:</strong> Case Report<br /> <strong> Setting:</strong> Tertiary Private Hospital<br /><strong>  Patient:</strong> One<br /><strong>RESULT:</strong> A  93-year-old  woman  had  multiple  admissions  for  recurrent  life  threatening  nose-bleeding  that  was  not  controlled  until  a  post-traumatic pseudoaneurysm  of  the  infraorbital artery was diagnosed and embolized.<br />CONCLUSION: The diagnosis of pseudoaneurysm should be considered in such cases, and treatment involving surgeons and interventional radiologists should be initiated to minimize morbidity and mortality.</p>

The Usefulness of Transcatheter Arterial Embolization for Panfacial Injury

PURPOSE: A life-threatening hemorrhage resulting from a severe facial fracture is rare, but it needs a prompt and aggressive treatment. Especially, a massive oronasal bleeding combined with midfacial fracture which may result from the rupture of the internal maxillary artery. With the recent advances in the radiologic intervention, its use has increased for managing these life threatening case. We reviewed its usefulness with our experiences and literatures. METHODS: A retrospective review was performed to determine the usefulness of the transcatheter arterial embolization in patients with panfacial trauma. If the vital signs were unstable, cardiopulmonary resuscitation was performed. Oronasal bleeding was controlled with nasal packing and electrocautery. All injured regions were studied by radiologic study including CT. Even after primary management, if the oronasal bleeding was persistent, radiologic intervention was performed 10 patients were treated with transcatheter arterial embolization and the bleeding focus controlled by embolization with polyvinyl alcohol and gelfoam. RESULTS: After the intervention, the vital signs became stable and there were no complications from embolization in the follow-up for 6 months. Also patients could recover through appropriate operations. CONCLUSION: Transcatheter arterial embolization for maxillofacial injury has many advantages for both, the doctor and the patient. First, less pain is induced than a compression device or an operation, which is another way to treat oronasal bleeding. Second, it does not need general anesthesia. And through a single procedure not only we can know the accurate bleeding point, but we can also bleeding by embolization.

False aneurysm in internal maxillary artery

The incident of false aneurysm of internal maxillary artery in the oral and maxillofacial region is known to be very rare. One case of false aneurysm in the internal maxillary artery is presented, which was experienced in our department. The etiology of this case is regarded as the mandibular condyle fracture, and/or iatrogenic trauma during open reduction. Clinically, there were systolic bruit on auscultation, pulsation and massive bleeding during operation. The lesion was finally diagnosed with angiography and treated by embolization procedure. False aneurysm can cause so massive bleeding as to threat the life of the patients. Therefore accurate diagnosis and treatment is very important. Angiography enables the solid diagnosis for the clinical one. And as the embolization has many advantages over the ligation, it can be a good treatment method.