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Singh HA, Kumar I, Singh PK, Varshney A, Verma A. Endovascular Management of Iatrogenic Pseudoaneurysm of Internal Maxillary Artery after Dental Extraction. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0041-1740576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractPseudoaneurysm developing from the internal maxillary artery is a rare but potentially fatal condition. We describe a case of iatrogenic pseudoaneurysm of the internal maxillary artery developed during dental extraction and successful endovascular closure of the feeder artery. At 2-month follow-up, the patient remained well with persistent thrombosis of pseudoaneurysm.
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Affiliation(s)
- Harsh Anand Singh
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pramod Kumar Singh
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anshul Varshney
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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2
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Al-Saadi NJ, Bakathir A, Al-Mashaikhi A, Al-Hashmi A, Al-Habsi A, Al-Azri F. Maxillary Artery Pseudoaneurysm as a Complication of Maxillofacial Injuries: Report of three cases and literature review. Sultan Qaboos Univ Med J 2019; 19:e364-e368. [PMID: 31897321 PMCID: PMC6930039 DOI: 10.18295/squmj.2019.19.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/26/2019] [Accepted: 09/19/2019] [Indexed: 11/16/2022] Open
Abstract
Traumatic maxillary artery pseudoaneurysm is an uncommonly reported complication in the field of oral and maxillofacial surgery. It is usually discovered incidentally, either early after trauma or weeks-to-months later. Quick recognition and prompt management are essential to avoid devastating consequences. In this paper, we report three uncommon cases of maxillary artery pseudoaneurysm recognised during the surgical management of maxillofacial injuries in Muscat, Oman. All cases presented as sudden brisk bleeding during the intraoperative surgical repair and were subsequently diagnosed and successfully managed by endovascular embolisation with platinum coils. This case report highlights the clinical presentation, diagnosis and management of maxillary artery pseudoaneurysm, in addition to a brief review of the literature.
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Affiliation(s)
- Noor J Al-Saadi
- Department of General Surgery, Al Rustaq Hospital, Al Rustaq, Oman
| | - Abdulaziz Bakathir
- Department of Dental & Maxillofacial Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al-Mashaikhi
- Oral and Maxillofacial Surgery Program, Oman Medical Specialty Board, Muscat, Oman
| | - Ahmed Al-Hashmi
- Department of Dental and Maxillofacial Surgery, Al Nahda Hospital, Muscat, Oman
| | | | - Faisal Al-Azri
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
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3
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Rawat SK, Singh D, Suresh Babu P, George R, Mongia P. Traumatic Pseudoaneurysm: A Life-Threatening Complication After Surgical Extraction of Impacted Maxillary Third Molar. J Maxillofac Oral Surg 2019; 18:57-60. [PMID: 30728693 DOI: 10.1007/s12663-018-1118-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/04/2018] [Indexed: 11/27/2022] Open
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.
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Affiliation(s)
- Saurabh Kumar Rawat
- 1Department of Oral and Maxillofacial Surgery, Government Dental College, Medical College Campus, Thiruvananthapuram, Kerala 695011 India
| | - Deepika Singh
- 2Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh 226003 India
| | - P Suresh Babu
- 1Department of Oral and Maxillofacial Surgery, Government Dental College, Medical College Campus, Thiruvananthapuram, Kerala 695011 India
| | - Rithin George
- 1Department of Oral and Maxillofacial Surgery, Government Dental College, Medical College Campus, Thiruvananthapuram, Kerala 695011 India
| | - Prakhar Mongia
- 1Department of Oral and Maxillofacial Surgery, Government Dental College, Medical College Campus, Thiruvananthapuram, Kerala 695011 India
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Gold M. Partially Thrombosed Internal Maxillary Pseudoaneurysm after Gunshot Wound. Craniomaxillofac Trauma Reconstr 2016; 9:335-337. [PMID: 27833712 DOI: 10.1055/s-0036-1582454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/24/2016] [Indexed: 10/21/2022] Open
Abstract
A 29-year-old man arrived in our emergency department after being shot on the face. Computed tomography (CT) revealed multiple facial bone fractures along the bullet trajectory. On day 10 of admission, CT angiogram of the neck revealed a partially thrombosed pseudoaneurysm in the parapharyngeal fat pad. The pseudoaneurysm was successfully treated with coil embolization. This report discusses diagnosis and treatment of a partially thrombosed internal maxillary artery pseudoaneurysm. Although digital subtraction angiography is the gold standard for pseudoaneurysm diagnosis, CT angiography may provide complimentary information, as seen in this case.
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Affiliation(s)
- Menachem Gold
- Department of Radiology, Lincoln Medical Center, New York City, New York
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Soh HY, Muda AS, Jabar NA, Nordin R, Nabil S, Ramli R. Non-pulsatile traumatic pseudoaneurysm of the internal maxillary artery following trauma to mandible. Oral Maxillofac Surg 2015; 19:423-5. [PMID: 25903486 DOI: 10.1007/s10006-015-0497-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/14/2015] [Indexed: 11/25/2022]
Abstract
Traumatic pseudoaneurysm involving the maxillary artery is rare. Owing to its anatomic location, internal maxillary artery is usually protected by its surrounding structures. Formation of pseudoaneurysm usually takes place after several weeks to months of the initial injury. In this case, we reported a pseudoaneurysm arising from left internal maxillary artery following blunt injuries within 3 hours after a road accident and the treatment with endovascular embolization with titanium coils prior to open reduction and internal fixation of the fractured mandibles.
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Affiliation(s)
- Hui Yuh Soh
- Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Ahmad Sobri Muda
- Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Nazimi Abd Jabar
- Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Rifqah Nordin
- Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - S Nabil
- Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Roszalina Ramli
- Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
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Katakol B, Govindaraj E. Pseudoaneurysm of the internal maxillary artery following mandibular condylar fracture. Ann Maxillofac Surg 2015; 4:201-4. [PMID: 25593875 PMCID: PMC4293846 DOI: 10.4103/2231-0746.147143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pseudoaneurysm of the internal maxillary artery is a rare occurrence. A well-organized pulsatile mass that develops after a traumatic event indicates a pseudoaneurysm. Such lesions are commonly misdiagnosed for an abscess or a hematoma. Pulsations and audible bruit are diagnostic features of an aneurysm. Rupture of such false aneurysms cause significant morbidity. Management is either surgical resection or embolization. Endovascular embolization is indicated in deep seated lesions or lesions with high morbidity. Though surgical resection is an invasive procedure, it is considered to be an alternative to embolization.
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Affiliation(s)
- Basavaraj Katakol
- Department of Oral and Maxillofacial Surgery, Government Dental College and Research Institute, Bellary, Karnataka, India
| | - E Govindaraj
- Department of Surgical Oncology, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India
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Ribeiro Ribeiro AL, Brasil da Silva W, Alves-Junior SDM, de Jesus Viana Pinheiro J. Giant life-threatening external carotid artery pseudoaneurysm caused by a mandibular condylar fracture. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e95-e100. [PMID: 25442245 DOI: 10.1016/j.oooo.2014.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/27/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Vascular lesions are rare complications associated to mandibular condylar fractures. This paper aims to describe a case of a giant pseudoaneurysm involving the external carotid artery (ECA) caused by a condylar fracture. CASE REPORT A 33-year-old man was the victim of traffic accident and presented with a panfacial fracture, including a bilateral condylar fracture. The condylar fracture was treated by closed reduction, and 4 weeks after treatment, the patient developed facial edema, which suggested postoperative infection. An attempt at draining it resulted in intensive bleeding. A computed tomographic angiography showed a huge pseudoaneurysm originating from the ECA. The patient was treated with surgery with ligation of the ECA and drainage of the pseudoaneurysm. CONCLUSION Vascular complications associated with condylar fractures are rare, but surgeons should be aware of this type of complication, especially because of the high risk of serious damage, including death. The use of computed tomographic angiography is very helpful in the diagnosis of vascular lesions and also guides treatment.
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Affiliation(s)
- André Luis Ribeiro Ribeiro
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University Center of Pará-CESUPA, Belém, Brazil.
| | - Walessa Brasil da Silva
- Department of Oral Pathology, School of Dentistry, Federal University of Pará-UFPA, Belém, Brazil
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Management of Late Post-traumatic Facial Artery Pseudoaneurysmal Cyst: Review of Literature. J Maxillofac Oral Surg 2014; 14:201-5. [PMID: 26028835 DOI: 10.1007/s12663-014-0678-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 07/23/2014] [Indexed: 10/24/2022] Open
Abstract
Pseudoaneurysms of the branches of the external carotid artery as a result of trauma are rare in oral and maxillofacial surgery practice. The most affected branches are the superficial temporal artery, internal maxillary artery and distal part of facial artery, usually where they pass over the bone. Very few cases of facial artery pseudoaneurysms of proximal parts (from external carotid artery up to the lower border of the mandible) are reported in the literature. We present a review of literature for management of late post-traumatic pseudoaneurysmal cyst and a case report involving proximal part of facial artery in the submandibular region following open reduction and rigid fixation of the condylar fracture in a 25-year-old male. To our knowledge this is the fourth reported case of proximal facial artery pseudoaneurysm.
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Kamath G, Naalla R, Pai VB, Narayanan R. Left maxillary artery pseudoaneurysm: a rare and late postoperative complication after head and neck cancer treatment. BMJ Case Rep 2014; 2014:bcr-2013-203078. [PMID: 24626453 DOI: 10.1136/bcr-2013-203078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 50-year-old man presented with pulsatile swelling in the left side of the face since 2 months and a continuous sinus discharge since 3 days. Three years earlier, he was operated for squamous cell carcinoma (SCC) of the left lower alveolus and underwent surgical excision with myocutaneous flap reconstruction, followed by chemoradiotherapy. CT angiogram of the expansile swelling revealed pseudoaneurysm of third part of the left maxillary artery and treated by surgical intervention.
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Affiliation(s)
- Ganesh Kamath
- Department of Cardiac Surgery, Kasturba Medical College, Manipal, Karnataka, India
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Maxillary artery pseudoaneurysm after Le Fort I osteotomy: treatment using transcatheter arterial embolization. J Craniofac Surg 2011; 21:1079-81. [PMID: 20613567 DOI: 10.1097/scs.0b013e3181e20693] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Life-threatening hemorrhage is a rare complication after Le Fort I osteotomy. However, owing to the gravity of this complication, all surgeons who perform Le Fort I osteotomy should be aware of the potential for this complication and options for its resolution. The following case report describes an episode of subacute, life-threatening bleeding, after a Le Fort I osteotomy for the treatment of midface hypoplasia. Emergent angiographic evaluation demonstrated an internal maxillary artery pseudoaneurysm with fistulous drainage via the cavernous sinus. This was treated by arterial embolization in which the pseudoaneurysm was packed with microcoils. This report reaffirms the importance of maintaining a high clinical suspicion for pseudoaneurysm as a possible etiology of delayed postoperative bleeding in patients after craniomaxillofacial surgery.
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Embolization of Pseudoaneurysm of the Internal Maxillary Artery After Orthognathic Surgery. J Craniofac Surg 2010; 21:1764-8. [DOI: 10.1097/scs.0b013e3181f40393] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Barbalho JCM, Santos ES, Menezes JMS, Gonçalves FR, Chagas OL. Treatment of pseudoaneurysm of internal maxillary artery: a case report. Craniomaxillofac Trauma Reconstr 2010; 3:87-9. [PMID: 22110821 DOI: 10.1055/s-0030-1254378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Pseudoaneurysms are rare lesions secondary to blunt or penetrating trauma, temporomandibular joint surgery, or orthognathic surgery. Nonsurgical interventions are the treatment of choice for pseudoaneurysms. In the case reported here, endovascular injection of acrylic glue was successful in the treatment of a pseudoaneurysm of the internal maxillary artery secondary to fracture of the zygomatic bone.
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13
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Silva AC, O'Ryan F, Beckley ML, Young HY, Poor D. Pseudoaneurysm of a Branch of the Maxillary Artery Following Mandibular Sagittal Split Ramus Osteotomy: Case Report and Review of the Literature. J Oral Maxillofac Surg 2007; 65:1807-16. [PMID: 17719403 DOI: 10.1016/j.joms.2005.12.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 12/05/2005] [Accepted: 12/28/2005] [Indexed: 10/22/2022]
Affiliation(s)
- Alessandro C Silva
- Division of Oral and Maxillofacial Surgery, Kaiser Permanente Hospital, Oakland, CA, USA
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