EJVES Extra
Volume 14, Issue 5 , Pages 54-55, November 2007

Traumatic Pseudoaneurysm of the Internal Maxillary Artery

  • R.K. Pinjala

      Affiliations

    • Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, AP, India
    • Corresponding Author InformationCorresponding author. R. K. Pinjala, MS, FRCSEd, FICS, Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, AP 500 082, India.
    • ,
  • S. Joshi

      Affiliations

    • Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, AP, India
    • ,
  • S. Rammurti

      Affiliations

    • Department of Interventional Radiology, Nizam's Institute of Medical Sciences, Hyderabad, AP, India

Accepted 26 August 2007. published online 05 November 2007.

Article Outline

Traumatic pseudoaneurysm of the internal maxillary artery (IMA) is rare. A patient with a pseudoaneurysm of IMA presented with a pulsatile swelling in the parotid region. Endovascular coils were deployed at neck of aneurysm and it was thrombosed. Pseudoaneurysms of IMA are difficult to approach surgically. Endovascular therapies can give early recovery with minimal morbidity and avoids injury to the facial nerve and its branches.

Keywords: Pseudoaneurysm, Fibered coils, Internal maxillary artery (IMA)

 

Back to Article Outline

Introduction 

Pseudoaneurysms are caused by rupture of arteries with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. This sac gradually expands and can rupture. It is rare to see pseudoaneurysms of IMA. They are usually associated with fracture neck of the mandible. IMA aneurysms can occur in any part of its course, but it is very rare to see pseudoaneurysms in the first, mandibular segment of the internal maxillary artery without fracture neck of the mandible but with fracture of the body of mandible and maxilla. We describe the management of traumatic internal maxillary artery pseudoaneurysm.

Back to Article Outline

Case Report 

A twenty four years old driver fell from a moving heavy vehicle and injured his face. The plastic surgeon fixed fractures of mandible and left maxilla with arch bar and dental wires. After 15 days a pulsatile swelling was noted in the right parotid region with clear fluid discharge from the right ear. He received broad spectrum antibiotics. He was not able to open the mouth due to pain. Orthopantogram showed intact fixation of fractured bones. MR Angiogram (Fig. 1), Digital subtraction angiogram (Fig. 2) showed a large pseudoaneurysm arising at the junction of IMA and superficial temporal artery. There were no communications from the opposite side. Two fibered coils were deployed at the neck of pseudoaneurysm (Fig. 2). The abnormal pulsations disappeared and pain subsided. The aneurysm was thrombosed. Post procedure recovery was uneventful.

Back to Article Outline

Discussion 

There are sporadic publications on the management of IMA aneurysms.1, 2, 3 These can be due to trauma, facial fractures, needle aspirations, mandibular osteotomies and infections. Some patients with cancers after radiation therapy to face develop IMA aneurysms. They can present as a painful, pulsatile swelling in the parotid region with facial nerve palsy, epistaxis and oral or throat bleeding depending on the segment of IMA involved. In our patient the swelling was noted 15 days after fixation of facial fractures. Duplex scan, MR angiography, Spiral CT angiography and Digital Subtraction Angiography have been used in the diagnosis. Endovascular Therapies (coils, glues) are preferred methods of treatments with minimal morbidity and they also maintain patency of internal maxillary artery in some cases.4, 5 Surgical approaches are more traumatic and facial nerve can be injured. When endovascular methods fail, surgery can be considered.

Back to Article Outline

References 

  1. Schwartz HC, Kendrick RW, Pogorel BS. False aneurysm of the maxillary artery. An unusual complication of closed facial trauma. Arch Otolaryngol. 1983;109:616–618
  2. Dorta JA, Shatney CH. Post traumatic Pseudoaneurysm of lateral maxillary artery. J Trauma. 1982;22:161–164
  3. Bradely JP, Elahi M, Kawamoto HK. Delayed presentation of Pseudo-aneurysms after Le Fort I Osteotomy. J Craniofac Surg. 2002;13(6):746–750
  4. Rogers SN, Patel M, Beirne JC, Nixon TE. Traumatic aneurysm of maxillary artery: the role of interventional radiology. Int J Oral Maxillofac Surg. 1995;24(5):336–339
  5. Hong JT, Lee SW, Ihn YK, Son BC, Sung JH, Kim IS, et al. Traumatic pseudoaneurysm of the superficial temporal artery treated by endovascular coil embolization. Surg Neurol. 2006;66(1):86–88

PII: S1533-3167(07)00031-3

doi:10.1016/j.ejvsextra.2007.08.003

Refers to article:

  • Traumatic Pseudoaneurysm of the Internal Maxillary Artery , 05 November 2007

    R.K. Pinjala, S. Joshi, S. Rammurti
    European Journal of Vascular & Endovascular Surgery January 2008 (Vol. 35, Issue 1, Page 127)

EJVES Extra
Volume 14, Issue 5 , Pages 54-55, November 2007

Article Tools

* Image Usage & Resolution