A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.
Aneurysm, False ; Angiography ; Arteries ; Blood Vessels ; Cautery ; Congenital Abnormalities ; Epistaxis ; Hemorrhage ; Maxillary Artery ; Orthognathic Surgery ; Osteotomy ; Postoperative Complications ; Postoperative Hemorrhage ; Veins

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.
Adhesives ; Aneurysm, False ; Angiography ; Dentistry ; Emergencies ; Enbucrilate ; Facial Nerve ; Female ; Hematoma ; Hemorrhage ; Humans ; Masticatory Muscles ; Maxillary Artery ; Needles ; Parotid Region ; Surgery, Plastic

OBJECTIVE: To investigate the methodology and efficacy of endoscopic sphenopalatine artery diathermy in management of refractory epistaxis. METHOD: Twenty patients with severe intractable posterior epistaxis, who had underwent various procedures like nasal packing, electro- or chemical cautery or others and still exacerbated, were subjected to this study. Under general anesthesia, according to the endoscopic anatomy of the sphenopalatine foramen, the sphenopalatine artery was identified under the posterior tip of the middle turbinate. After the pedicle of the artery was delineated, a bipolar cauterized the artery and transected it. RESULT: Twenty patients have been followed up for 5 to 20 months with an average of 10 months. No patients suffered recurrent epistaxis during the period. Only 1 patients in this series reported minor nasal adhesion. CONCLUSION Diathermy of sphenopalatine artery, as a purely endonasal procedure, is an effective and microinvasive means of achieving long-term control of refractory epistaxis. It has few complications associated with other forms of arterial ligation.
Adult ; Aged ; Diathermy ; methods ; Endoscopy ; Epistaxis ; surgery ; Female ; Humans ; Male ; Maxillary Artery ; surgery ; Middle Aged ; Treatment Outcome

OBJECTIVE: To explore the rules about the pathway and branch patterns of the internal maxillary artery in pterygopalatine fossa, provide the anatomic basis for treating the internal maxillary artery during the transnasal endoscopic surgery. METHOD: Ten adult cadaveric skull base were dissected, the sphenopalatine artery and its branches were observed. The pterygopalatine fossa was opened through trans-maxillary sinus endoscopic approach, all the branches of the internal maxillary artery in pterygopalatine fossa were exposed. The concave of the maxillary sinus posterior-medial wall was defined as point A, the cross point of the horizontal line pass through the infraorbital foramen, the maxillary sinus anterior wall and posterior-lateral wall as point B, the cross point of the maxillary sinus anterior wall, floor and posterior-lateral wall as point D, the midpoint of BD as C, the C' denoted the first branch root of internal maxillary artery in pterygopalatine fossa. Observed the pterygopalatine segment of internal maxillary artery based on the marking points. RESULT: The distance between the sphenoid sinus os and the sphenopalatine fossa was (5.88 +/- 2.21) mm. The C' point locate on AC at 13 sides specimen, locate on AB at 5 sides specimen, locate on AC at 1 side specimen, higher than AB at 1 side specimen. CONCLUSION Being familiar with the pathway and branch patterns of the internal maxillary artery in pterygopalatine fossa is important for treating the uncontrol epistaxis and endoscopic pterygopalatine fossa surgery, the rules described by A, B, C, D in our experiments will be helpful in ligation of internal maxillary artery during the endoscopic transnasal/maxillary-pterygopalatine fossa surgery.
Adult ; Endoscopy ; Humans ; Maxillary Artery ; anatomy & histology ; surgery ; Pterygopalatine Fossa ; anatomy & histology ; surgery ; Sphenoid Sinus ; anatomy & histology

We report a new approach of embolization in a 15-year-old boy that presented with a massive hemorrhage from a maxillary arteriovenous malformation. Re-bleeding occurred after emergent ligation of the external carotid artery. The bleeding was successfully controlled by embolization via the superficial temporal artery.
Adolescent ; Arteriovenous Malformations/*therapy ; Carotid Artery, External/surgery ; Embolization, Therapeutic/*methods ; Hemorrhage/etiology/therapy ; Humans ; Ligation ; Male ; Maxillary Artery/*abnormalities ; Temporal Arteries

PURPOSE: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy. METHODS: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. RESULTS: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months. CONCLUSION: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.
Aneurysm, False ; Angiography ; Embolization, Therapeutic ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Maxillary Artery ; Osteotomy* ; Prognathism ; Surgery, Plastic ; Young Adult

PURPOSE: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy. METHODS: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. RESULTS: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months. CONCLUSION: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.
Aneurysm, False ; Angiography ; Embolization, Therapeutic ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Maxillary Artery ; Osteotomy* ; Prognathism ; Surgery, Plastic ; Young Adult

OBJECTIVE: To provide anatomic data of pterygopalatine fossa(PPF) for endoscopic PPF surgery. METHOD: Fifteen wet adult skull specimen fixed in 10% formaldehyde were studies. From center the skulls were sawed, the middle and inferior turbinate were resected, the anterior and posterior ethmoid sinuses were resected. Then after punch out perpendicular part of palatine bone and posterior wall of maxillary,the pterygopalatine fossa were showed and some related measurements were made. RESULT: This pathway can lead to a good view of pterygopalatine fossa. The main soft structures in PPF were maxillary artery and nerve with their branches. The diameter of artery branches was smaller than 3 mm. CONCLUSION The endoscopic PPF surgery is safe and practical from the anatomic data.
Adult ; Endoscopy ; Ethmoid Sinus ; anatomy & histology ; Humans ; Maxilla ; anatomy & histology ; Maxillary Artery ; anatomy & histology ; Maxillary Sinus ; anatomy & histology ; surgery ; Nasal Cavity ; surgery ; Palate, Hard ; anatomy & histology ; Pterygopalatine Fossa ; anatomy & histology ; surgery

OBJECTIVETo investigate the feasibility and safety of intraoral submandibular gland excision.

METHODSAnalyze the relationship between the external maxillary artery and submandibular gland, and offer a reliable anatomical base for 10 cases of intraoral submandibular gland excision, including 8 cases of chronic sialadenitis, 1 case of pleomorphic adenoma and 1 case of cyst of submandibular gland.

RESULTSThe external maxillary artery went across the surface of gland submandibular, and its branches provided nutrition for the gland in most cases. The results of 10 cases intraoral submandibular gland excision were effective and satisfied, without major complications. The average time of operation was 50 minutes and the average hemorrhage of operation was 60 ml.

CONCLUSIONIntraoral submandibular gland excision is safe and feasible for chronic sialadenitis and cyst of submandibular gland and some of benign tumor submandibular gland as long as indications strictly controlled and the external maxillary artery well coped with.

Adolescent ; Adult ; Female ; Humans ; Maxillary Artery ; surgery ; Middle Aged ; Sialadenitis ; surgery ; Submandibular Gland ; anatomy & histology ; surgery ; Submandibular Gland Diseases ; surgery ; Submandibular Gland Neoplasms ; surgery ; Treatment Outcome ; Young Adult

We investigated the surgical outcome of radical maxillectomy in advanced maxillary sinus cancers invading through the posterior wall and into the infratemporal fossa. Twenty-eight patients with maxillary sinus squamous cell carcinoma, who visited the Otorhinolaryngology Department at Severance Hospital from March, 1993 to February, 2001 and underwent the surgery, were analyzed retrospectively by reviewing clinical medical records and radiologic test results. The mean follow- up period was 78.8 months. (26 -162 months) Local recurrence, sites of local recurrence, and the 2-year disease-free survival rate were analyzed. Of the total 28 cases, 9 cases were T3, and 19cases were T4. Total maxillectomy was performed in 12 cases (42.9%) and radical maxillectomy in 16 cases (57.1%). Regardless of staging, radical maxillectomy was performed only when cancers invaded through the posterior wall and into the infratemporal fossa. When cancers only maginally or did not invade the posterior wall, total maxillectomy was performed. The 2-year disease-free survival rate was 75% for both total and radical maxillectomy, and the local recurrence rates were 8.3% and 18.7% respectively. All recurrence occurred at the posterior resection margin of the maxillectomy. We strongly recommend the use of radical maxillectomy in the cases of advanced maxillary sinus cancers invading the infratemporal fossa. Radical maxillectomy can provide sufficient safety margins and lower the local recurrence rate.
Adult ; Aged ; Carcinoma, Squamous Cell/mortality/pathology/*surgery ; Disease-Free Survival ; Female ; Humans ; Male ; Maxilla/blood supply/*surgery ; Maxillary Artery/surgery ; Maxillary Neoplasms/mortality/pathology/*surgery ; Maxillary Sinus/*surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome