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.
Anesthesia, General ; Cardiopulmonary Resuscitation ; Electrocoagulation ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemorrhage ; Humans ; Maxillary Artery ; Maxillofacial Injuries ; Polyvinyl Alcohol ; Retrospective Studies ; Rupture ; Vital Signs

Two cases of massive epistaxis following nonpenetrating head injury are reported. A 23-year-old man was referred to us because of massive epistaxis and binocular blindness which developed about two months after a head injury. Carotid angiography demonstrated a intracavernous carotid aneurysm protruding into the ethmoid and sphenoid sinuses, and occlusion of the supraclinoid part of contralateral carotid artery. CT scan demonstrated a large hyperdense mass extending into the parasellar area, the ethmoid and sphenoid sinuses, and both orbits with destruction of bony structures. Treatment was delayed because the patient developed typhoid fever and sepsis, he died about six months after a head injury from a severe cerebral infarction due to internal carotid artery occlusion. A 34-year-old man, involved in a car accident, was admitted in semicomatose state. Over the next 72 hr he become more alert but he had massive epistaxis 11 day later which required blood transfusions. Carotid angiography revealed a false aneurysm of the distal part of the internal maxillary artery. About 30 days later, the false aneurysm occluded by embolization with Gelfoam. The patient recovered uneventfully from these procedures.
Adult ; Aneurysm ; Aneurysm, False ; Angiography ; Blindness ; Blood Transfusion ; Carotid Arteries* ; Carotid Artery Injuries* ; Carotid Artery, External ; Carotid Artery, Internal ; Cerebral Infarction ; Craniocerebral Trauma* ; Epistaxis* ; Gelatin Sponge, Absorbable ; Head Injuries, Closed ; Head* ; Humans ; Maxillary Artery ; Orbit ; Sepsis ; Sphenoid Sinus ; Telescopes ; Tomography, X-Ray Computed ; Typhoid Fever ; Young Adult

OBJECTIVE: To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. MATERIALS AND METHODS: For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. RESULTS: Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. CONCLUSION: In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.
Adolescent ; Adult ; Aneurysm, False/radiography/*therapy ; Angiography, Digital Subtraction ; Angioplasty, Balloon ; Carotid Artery Injuries/radiography/*therapy ; Carotid Artery, Internal ; Diagnosis, Differential ; Embolization, Therapeutic ; Endovascular Procedures/*methods ; Epistaxis/radiography/*therapy ; Female ; Humans ; Male ; Maxillary Artery/*injuries ; Middle Aged ; Retrospective Studies ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: We report a case of a 38-year-old man who suffered a blowout fracture of the orbital wall with an intact eyeball entrapped within the maxillary sinus after trauma. CASE SUMMARY: The 38-year-old man was admitted to the emergency room after sustaining a work-related trauma. His chief complaints were loss of vision and bleeding from the left periorbital area. He had no light perception and no eyeball was found in the orbit. Facial CT revealed that the intact eyeball was entrapped within the maxillary sinus. The condition of the optic nerve was difficult to ascertain. Ten hours after post-trauma, reduction surgery was done with a graft from the iliac bone. Ruptured extraocular muscles were not primarily sutured. After four months, vitrectomy was performed on the left eye. The eyeball was repositioned in its place. He had no light perception. Extraocular motility improved at the last follow-up examination. CONCLUSIONS: We report the dislocation of the eyeball globe into the maxillary sinus after a blowout fracture. Visual acuity showed no light perception as a result of central retinal artery occlusion and optic nerve injury. We were able to obtain a good aesthetic and functional result after the operation.
Adult ; Dislocations ; Emergencies ; Eye ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypogonadism ; Light ; Maxillary Sinus ; Mitochondrial Diseases ; Muscles ; Ophthalmoplegia ; Optic Nerve ; Optic Nerve Injuries ; Orbit ; Retinal Artery Occlusion ; Transplants ; Vision, Ocular ; Visual Acuity ; Vitrectomy