J Cerebrovasc Endovasc Neurosurg.  2016 Jun;18(2):83-89. 10.7461/jcen.2016.18.2.83.

Endovascular Treatment to Stop Life-threatening Bleeding from Branches of the External Carotid Artery in Patients with Traumatic Maxillofacial Fracture

• Lee W
• Shim YS
• Chung J

• KMID: 2354881
• DOI: http://doi.org/10.7461/jcen.2016.18.2.83

Abstract

OBJECTIVE
The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures.
MATERIALS AND METHODS
A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated.
RESULTS
Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes.
CONCLUSION
It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.

Keyword

Endovascular procedures; Facial bones; Hemorrhage; Maxillary artery; Maxillary fractures

MeSH Terms

Accidental Falls
Accidents, Traffic
Blood Pressure
Body Temperature
Carotid Artery, External*
Endovascular Procedures
Erythrocytes
Facial Bones
Follow-Up Studies
Glasgow Coma Scale
Groin
Hemorrhage*
Humans
Maxillary Artery
Maxillary Fractures
Plasma
Punctures

Figure

• 

  Fig. 1 Selective angiography of the external carotid artery demonstrated contrast extravasation (indicated [A] by arrow heads in a 77-year-old female and [B] by a circle in a 62-year-old male) in the third (pterygomaxillary) part of the internal maxillary artery indicated by a white arrow). IMA = internal maxillary artery.

• 

  Fig. 2 Pearson's correlation coefficients were calculated and showed the significance of the linear relationship between Glasgow Outcome Scale at discharge and the various factors, such as (A) initial Glasgow Coma Scale, (B) lowest systolic blood pressure, (C) lowest body temperature, (D) red blood cells transfusion, (E) fresh frozen plasma transfusion, and (F) the time from arrival to groin puncture.

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