Delayed rupture of a posttraumatic retromaxillary pseudoaneurysm causing massive bleeding: a case report

Abstract

Posttraumatic pseudoaneurysm of the face is caused by blunt, penetrating, or surgical trauma. Although its incidence is low, pseudoaneurysm rupture can cause a life-threatening, massive hemorrhage. A 48-year-old man visited our emergency center due to a fall-down accident. Three-dimensional computed tomography (CT) showed a comminuted zygomaticomaxillary complex fracture of the left face. After open reduction and internal fixation, the surgical wound healed without any complications. However, the patient was readmitted 10 days after surgery due to pus-like discharge from the wound. Contrast-enhanced CT to find the abscess unexpectedly revealed a pseudoaneurysm in the left retromaxillary area. Massive oral bleeding occurred on the night of re-hospitalization and emergency surgery was done. The bleeding site was identified as a pseudo-aneurysmal rupture of the posterior superior alveolar artery in the retromaxillary area. Hemostasis was achieved by packing Vaseline gauze in the maxillary sinus using an endoscope. Delayed rupture and massive bleeding of posttraumatic retromaxillary pseudoaneurysm after a zygomaticomaxillary fracture is a low-probability, but high-impact event. Therefore, additional contrast-enhanced CT should be considered to evaluate the possibility of a posttraumatic pseudoaneurysm in cases of severe comminuted zygomaticomaxillary fracture.

Ruptured pseudoaneurysm of the internal maxillary artery in zygomaticomaxillary fracture: a case report

“…A post-traumatic pseudoaneurysm forms when the blood vessel walls are partially ruptured and the blood flow between the arterial laceration and hematoma is maintained. As leakage continues, the hematoma expands; this leads to a pseudoaneurysm [ 6 , 7 ]. Patients may present with delayed epistaxis when arterial damage leads to pseudoaneurysm formation and rupture [ 8 ].…”

“…Facial pseudoaneurysms, in particular, usually form within days to weeks after the occurrence of blunt trauma [ 6 ]. The latent period can vary from several days to several years due to a gradual weakening of the arterial wall and erosion of adjacent bones, with most pseudoaneurysms arising within 3 weeks (88%) after the trauma [ 8 ].…”

“…Although post-traumatic pseudoaneurysms of the internal maxillary artery and its branches are rare, they can be life-threatening; thus, their rapid diagnosis and treatment are important [ 1 , 3 , 4 , 6 ]. The treatment options for pseudoaneurysms include direct compression, tissue removal, and embolization with selective angiography using contrast agents [ 6 , 12 ]. In the current case, the patient received a radiological intervention for the treatment of the pseudoaneurysm, after which an ORIF was performed to repair the ZMC fracture.…”

“…Only a few cases of preoperatively discovered post-traumatic pseudoaneurysms that affected the internal maxillary artery after a facial bone fracture have been reported. In these cases, the bleeding occurred postoperatively [ 3 , 4 , 6 ]. Herein, we report a case of intractable epistaxis that occurred just before open reduction and internal fixation (ORIF) in a patient with a zygomaticomaxillary complex (ZMC) fracture.…”

Pseudoaneurysm of the superficial temporal artery after blunt trauma: case report and literature review

“…If left untreated, a pseudoaneurysm may rupture and can cause a life-threatening hemorrhage, although its incidence is low [ 14 ]. Hemostasis can be extremely challenging even using a surgical approach.…”