Angioembolisation in Maxillofacial Trauma: An Initial Experience in a Tertiary Care Center

Abstract

Purpose To analyze the safety, efficacy and outcome of angio-embolization in the management of refractory oronasal bleeding in patients of severe maxillofacial trauma. Materials and Methods It was a retrospective analysis of 21 patients who were managed by angio-embolisation to control refractory oro-nasal bleeding in severe maxillofacial trauma from December 2010 to December 2013. The patient population included 19 males and 2 females and the age ranged from 16 to 55 years (mean age of 29.6 years). Gelfoam pledgets and coils were used as embolising agents in branches of external carotid arteries. Embolising coils were preferably used to block actively bleeding vessels on angiography. Results Road traffic accidents were the etiology in 17 patients and fall from height (two), assault (one) and gunshot injury (one) in the rest. Twelve (52 %) patients showed active contrast extravasation on angiography. Active arterial bleeding was observed from branches of internal maxillary [11], facial [2] and lingual arteries [4]. Gel foam embolisation alone was done in 16 patients, coil embolisation alone in two patients and both coil and gel foam embolisation in three patients. The procedures were technically successful in twenty (95 %) patients. None of the patients had procedure related complications. Nine patients (42 %) succumbed to their associated injuries later, in which five patients had severe head injuries and four patients had history of hemorrhagic shock and cardiac arrest prior to the procedure. Conclusion Angio-embolisation is a safe and effective technique in managing intractable bleeding in maxillofacial injuries.

Modern Management of Maxillofacial Injuries

“…In 70% of cases of traumatic intractable epistaxis, the internal maxillary artery, or one of its branches, is injured [9,23]. That's why transantral ligation of the internal maxillary artery was described [24,25].…”

Systematic review and meta‐analysis of arterial embolization compared with traditional management on outcomes of traumatic massive facial haemorrhage

“…Historically, ligation of the external carotid artery has been suggested as a final attempt to control haemorrhage 2,10 . However, given the rich anastomosis and collateral supply of the face, it is rarely effective 13,14,18,21 …”

“…3 Emergency surgical intervention for control of oronasal haemorrhage can include manual compression, ligation of vessels and temporary fixation of fractures. 3,7,17,18 Ligation of vessels and temporary fixation of fractures is recommended by many authors for haemorrhage control, 3,5,7,8,12,19,20 however, there are significant risks. This requires a general anaesthetic, with airway management being difficult in the presence of significant swelling and haemorrhage.…”

“…2,10 However, given the rich anastomosis and collateral supply of the face, it is rarely effective. 13,14,18,21 Transarterial embolization (TAE) was pioneered in 1930 by Brooks, 22 with Rosch and Dotter utilizing it for the first time in management of a traumatic vascular injury in 1972. 23 In recent years, TAE has had a growing role in the management of traumatic haemorrhage, particularly in the unstable haemorrhagic patient, where super-selective embolization can occur quickly and without the need for a general anaesthetic.…”