Imaging Sci Dent.  2018 Dec;48(4):295-300. 10.5624/isd.2018.48.4.295.

Applications of digital subtraction angiography in the management of penetrating injuries of the maxillofacial region: A case report

• Fonseca VJ
• Martins Chaves RR
• Baires Campos FE
• Lehman LF
• Moraes GM
• Castro WH

• KMID: 2450171
• DOI: http://doi.org/10.5624/isd.2018.48.4.295

Abstract

This report presents a clinical case of trauma due to assault with a knife, and describes the importance of using the correct imaging modality in cases of facial penetrating trauma involving the superficial and deep anatomical planes. Penetrating wounds in the maxillofacial region are rare and poorly reported, but can result in serious complications that are difficult to resolve and may compromise the patient's quality of life, especially when large blood vessels or other vital structures are involved. Thus, it is essential to determine the extent of the affected blood vessels and the proximity of the retained object to the anatomical structures. In this case, digital subtraction angiography was the imaging modality chosen. The use of appropriate imaging examinations allows a proper map of the surgical field, reducing the chances of vascular damage during the surgical procedure.

Keyword

Wounds, Penetrating; Angiography, Digital Subtraction; Maxillofacial Injuries

MeSH Terms

Angiography, Digital Subtraction*
Blood Vessels
Maxillofacial Injuries
Quality of Life
Wounds, Penetrating

Figure

• 

  Fig. 1 Preoperative computed tomographic images. A. A coronal image shows the knife fragment in the region of the infratemporal fossa and nasopharynx. B. An axial image shows the knife fragment in the region of the infratemporal fossa and nasopharynx. C. A 3-dimensional reconstructed image reveals the knife path. D. A 3-dimensional reconstruction demonstrates the fracture of the left condylar head.

• 

  Fig. 2 Selective digital subtraction angiography images of the internal carotid arteries show the penetrating object, indicated with yellow arrows. A. Anteroposterior view of the right internal carotid artery. B. Lateral view of the right internal carotid artery. C. Posteroanterior view of the left internal carotid artery. D. Lateral view of the carotid artery.

• 

  Fig. 3 Selective digital subtraction angiography images of the external carotid arteries show the penetrating object, indicated with yellow arrows. A. Anteroposterior view of the right external carotid artery. B. Lateral view of the right external carotid artery. C. Anteroposterior view of the left external carotid artery. D. Lateral view of the left external carotid artery.

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  Fig. 4 Surgical procedure. A. Surgical access performed to remove the penetrating object. B. The removed fragment of the knife.

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