Contralateral traumatic carotid cavernous fistula after a craniomaxillofacial fracture

Abstract

Introduction Carotid-cavernous fistula is an abnormal communication between the internal carotid artery, the external carotid artery or any of their branches and the cavernous sinus. This condition may occur spontaneously or after craniofacial trauma; in this case the fistula takes place on the same side as the craniofacial fracture and becomes symptomatic within a few weeks. The diagnosis is clinical; it must be evoked before any post-traumatic proptosis. Treatment must be started quickly to avoid visual or even vital complications. Case presentation We report the case of a 19 years old male patient who was admitted to the maxillofacial surgery department for osteosynthesis of a fracture of the left orbital roof after a traffic accident. The three-month's examination noted a right pulsatile proptosis with redness and decrease of the visual acuity. The cerebral MRI was in favor of a right sided direct CCF, which was confirmed by the arteriographie. The patient responded very well to embolization. Discussion Craniofacial trauma is a major cause of carotid cavernous fistula. When a patient has ophthalmic manifestations of vascular complications, early detection of CCF is important for preserving visual acuity. The diagnosis is mainly clinical based on the ophthalmological symptoms. CT and MRI scans show the indirect signs of the fistula. There are several types of invasive and non-invasive treatments. The evolution of the fistula is generally favorable and recurrence is not very frequent. Conclusion This case report is a documentation on an exceptional case of posttraumatic direct CCF occurring on the contralateral side of the skull base fracture.

La fistula carótido-cavernosa como complicación tardía del traumatismo maxilofacial y de base de cráneo.

“…La FCC es una complicación rara con una incidencia del 0,2 % 2 , no por ello menos importante, ya que las secuelas pueden ser graves como la pérdida de visión de forma definitiva. Puede afectar al lado contralateral del traumatismo como describen Elmrini y cols., por lo que se deben explorar ambos ojos 4 .…”

“…Exhibe una disminución o desaparición tras la aplicación de compresión en la ACI ipsilateral. Puede también aparecer pérdida de agudeza visual 4 .…”