Arch Craniofac Surg.  2016 Mar;17(1):28-30. 10.7181/acfs.2016.17.1.28.

Massive Hemorrhage Facial Fracture Patient Treated by Embolization

• Kim MH
• Yoo JH
• Kim SS
• Yang WS

• KMID: 2159965
• DOI: http://doi.org/10.7181/acfs.2016.17.1.28

Abstract

Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate.

Keyword

Angiography; Maxillary artery; Maxillary fractures

MeSH Terms

Aged
Airway Obstruction
Angiography
Arteries
Emergencies
Employment
Hemorrhage*
Humans
Male
Maxillary Artery
Maxillary Fractures
Mortality
Motor Vehicles
Resuscitation
Vital Signs