J Korean Neurotraumatol Soc.  2011 Oct;7(2):108-111. 10.13004/jknts.2011.7.2.108.

Endovascular Treatment of Life-Threatening Bleeding of Bilateral Maxillary Arteries in a Patient with Multiple Facial Bone Fractures: A Case Report

• Kim DY
• Hyun DK
• Park H
• Chung J

• KMID: 2019924
• DOI: http://doi.org/10.13004/jknts.2011.7.2.108

Abstract

Bleeding from bilateral internal maxillary artery (IMA) injury may result in a life-threatening situation and greater urgency for resuscitation. Here we report a case of life-threatening bleeding of bilateral maxillary arteries in multiple facial bone fractures, which was treated by endovascular treatment. A 77-year-old woman sustained a fall from five meters height. She was transferred to our institution with stuporous consciousness, active oronasal bleeding, multiple facial laceration, facial deformity and both forearm swelling. Selective angiography of bilateral external carotid arteries (ECA) demonstrated contrast extravasation in the distal branches of the right IMA and in the proximal segment of the left IMA involving the left middle meningeal artery. Endovascular embolization with polyvinyl alcohol (PVA) particle successfully stopped bleeding from the bilateral IMA. At one-year clinical follow-up, she recovered without any neurological deficit except some clumsiness of her both hands due to bilateral radioulnar fractures. In patients with life-threatening bleeding from bilateral IMA, endovascular embolization with PVA particle may be considered as a good treatment option.

Keyword

Endovascular treatment; Facial bone fractures; Maxillary artery injury; PVA particle

MeSH Terms

Angiography
Carotid Artery, External
Congenital Abnormalities
Consciousness
Facial Bones
Female
Follow-Up Studies
Forearm
Hand
Hemorrhage
Humans
Lacerations
Maxillary Artery
Meningeal Arteries
Polyvinyl Alcohol
Resuscitation
Stupor
Polyvinyl Alcohol

Figure

• 

  FIGURE 1 Brain (on the right side) and facial computed tomography (on the left side) showed multiple facial bone fractures and pneumocephalus without intracranial hemorrhage.

• 

  FIGURE 2 A: Selective angiography of right external carotid arteries (ECA) demonstrated contrast extravasation in the distal branches of the internal maxillary artery (IMA). B: After the embolization, the right ECA angiography demonstrated disappearance of the extravasation in the distal branches of the right IMA. C: Selective angiography of left ECA showed contrast extravasation in the proximal segment of the left IMA involving the left middle meningeal artery (MMA). D: After embolization of the left IMA with PVA particles (range of particle size, 250-350 microns), the IMA segment involving the MMA was occluded and the extravasation was disappeared.

Reference

1. Ardekian L, Samet N, Shoshani Y, Taicher S. Life-threatening bleeding following maxillofacial trauma. J Craniomaxillofac Surg. 1993; 21:336–338.

2. Bynoe RP, Kerwin AJ, Parker HH 3rd, Nottingham JM, Bell RM, Yost MJ, et al. Maxillofacial injuries and life-threatening hemorrhage: treatment with transcatheter arterial embolization. J Trauma. 2003; 55:74–79.

3. Chen CC, Jeng SF, Tsai HH, Liliang PC, Hsieh CH. Life-threatening bleeding of bilateral maxillary arteries in maxillofacial trauma: report of two cases. J Trauma. 2007; 63:933–937.

4. Elahi MM, Parnes LS, Fox AJ, Pelz DM, Lee DH. Therapeutic embolization in the treatment of intractable epistaxis. Arch Otolaryngol Head Neck Surg. 1995; 121:65–69.

5. Elden L, Montanera W, Terbrugge K, Willinsky R, Lasjaunias P, Charles D. Angiographic embolization for the treatment of epistaxis: a review of 108 cases. Otolaryngol Head Neck Surg. 1994; 111:44–50.

6. Hashim HA, Atiyeh BS, Kayle DI, Dandan I. Balloon compression of the intramaxillary sinus for intractable post-traumatic bleeding from the maxillary artery. Case report. Scand J Plast Reconstr Surg Hand Surg. 1999; 33:321–324.

7. Komiyama M, Nishikawa M, Kan M, Shigemoto T, Kaji A. Endovascular treatment of intractable oronasal bleeding associated with severe craniofacial injury. J Trauma. 1998; 44:330–334.

8. Sakamoto T, Yagi K, Hiraide A, Takasu A, Kinoshita Y, Iwai A, et al. Transcatheter embolization in the treatment of massive bleeding due to maxillofacial injury. J Trauma. 1988; 28:840–843.

9. Schaitkin B, Strauss M, Houck JR. Epistaxis: medical versus surgical therapy: a comparison of efficacy, complications, and economic considerations. Laryngoscope. 1987; 97:1392–1396.

10. Shimoyama T, Kaneko T, Horie N. Initial management of massive oral bleeding after midfacial fracture. J Trauma. 2003; 54:332–336. discussion 336.

11. Wang L, Vogel DH. Posterior epistaxis: comparison of treatment. Otolaryngol Head Neck Surg. 1981; 89:1001–1006.

12. Yang WG, Tsai TR, Hung CC, Tung TC. Life-threatening bleeding in a facial fracture. Ann Plast Surg. 2001; 46:159–162.