ABSTRACT
In orthognathic surgery, Le Fort I osteotomy is one of the most often used methods for the correction of dental-facial deformities and is considered technically safe. However, this procedure may lead to diverse complications, including uncommon vascular complications. A clinical case is described of late development of pseudoaneurysm in one of the branches of the maxillary artery in a 20-year-old patient who had undergone Le Fort I osteotomy, bilateral sagittal osteotomy of mandibular branch, and mentoplasty and subsequently treated with embolization. The main forms of treating vascular injuries are reviewed, and embolization is demonstrated to be a technically safe procedure with few complications.
Subject(s)
Aneurysm, False/therapy , Embolization, Therapeutic/methods , Maxilla/surgery , Maxillary Artery/injuries , Orthognathic Surgical Procedures/adverse effects , Osteotomy, Le Fort/adverse effects , Aneurysm, False/etiology , Chin/surgery , Edema/etiology , Embolization, Therapeutic/instrumentation , Epistaxis/etiology , Follow-Up Studies , Humans , Male , Malocclusion, Angle Class III/surgery , Mandible/surgery , Maxilla/abnormalities , Open Bite/surgery , Osteotomy/methods , Postoperative Complications , Young AdultABSTRACT
OBJECTIVE: To assess the role of this procedure to prevent hemorrhage in cerebral arteriovenous malformations (cAVM). METHOD: Between 1992 and 2000, we studied 104 patients submitted to embolization as the main treatment. Patients were followed until hemorrhage or death. RESULTS: Follow-up ranged from 1.6 months to 8 years. The most frequent presentations were hemorrhage (50%) and seizures (38%). In addition, 40% were small (<30 mm); 56% were medium (30-60 mm). Obliteration was < or =1/3 in 11% of the cases; from 1/3 to < or = 2/3 in 49%; >2/3 in 36%; complete in 5%. The risk of death was 1%/year, and of bleeding, 5.4%/year. Presentation with hemorrhage and low obliteration rate were the main factors associated with hemorrhage. CONCLUSION: cAVM embolization provides limited protection against hemorrhage with obliteration rates below 2/3. Presentation with hemorrhage is the main factor for predicting hemorrhage.
Subject(s)
Embolization, Therapeutic , Enbucrilate/therapeutic use , Intracranial Arteriovenous Malformations/therapy , Intracranial Hemorrhages/prevention & control , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk Factors , Treatment OutcomeABSTRACT
OBJETIVO: Avaliar o papel deste procedimento na prevenção de hemorragia em casos de malformação arteriovenosa (MAV) cerebrais. MÉTODO: Entre 1992 e 2000, estudamos 104 pacientes submetidos a embolização como tratamento principal. Os pacientes foram seguidos até a ocorrência de hemorragia ou morte. RESULTADOS: O período de seguimento variou de 1,6 mês a 8 anos. As apresentações mais freqüentes foram hemorragia (50%) e convulsões (38%). Além disso, 40% das lesões eram pequenas (<30 mm); 56% eram médias (30-60 mm). O grau de obliteração foi <1/3 em 11% dos casos; 1/3 a <2/3 em 49%; >2/3 em 36%; completa em 5%. O risco de morte foi 1%/ano, e de sangramento, 5,4%/ano. Apresentação com hemorragia e baixo grau de obliteração foram os principais fatores associados com hemorragia. CONCLUSÃO: A embolização em MAVs cerebrais confere proteção limitada contra hemorragia, com graus de obliteração abaixo de 2/3. Apresentação com hemorragia é o principal fator preditivo de hemorragia.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Embolization, Therapeutic , Enbucrilate/therapeutic use , Intracranial Arteriovenous Malformations/therapy , Intracranial Hemorrhages/prevention & control , Follow-Up Studies , Risk Factors , Treatment OutcomeABSTRACT
Apresentam-se os tipos de hemorragias intracranianas näo-traumáticas que ocorrem no período neonatal e na criança maior, discutindo-se a etiologia, aspectos clínicos, laboratoriais e radiológicos, prognóstico e tratamento
