Superficial temporal artery pseudoaneurysm following facial trauma

Abstract

A 68-year-old man presented with rapid swelling of the right forehead 11 days after sustaining a laceration secondary to a fall. Presumed to be an abscess due to retained foreign body, needle aspiration was performed and arterial blood obtained. Doppler ultrasound revealed a 3 cm mixed echogenicity lesion with 'see-sawing' internal Doppler flow arising from the superficial temporal artery (STA), in keeping with a pseudoaneurysm. Treatment options including interventional radiology and open surgery were considered. Open operative intervention with direct surgical ligation provided an excellent outcome. Delayed pseudoaneurysm of the STA is a rare complication of trauma but should be considered in the differential of a traumatic lateral forehead swelling to prevent complications and inappropriate investigations and management.

Posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery: A case report

“…The determining causes were the alteration of the arterial layers and the risk of rupture of continuity by a penetrating wound (prickly, sharp instruments or firearms). Similarly, cases have been reported following a facial trauma, or iatrogenic pseudoaneurysm of the superficial temporal artery [ 11 ]. It is surprising, given the high incidence of forearm and hand injuries, that pseudoaneurysms are less frequent.…”

Superficial temporal artery pseudoaneurysm: Report of two cases and review

“…2 Given its relatively superficial location and underlying bony structures, it is particularly vulnerable to trauma to the head. 3 STA pseudoaneurysms occur in patients in their second or third decades, with a male to female ratio of 4:1. A later peak in older people who are prone to falls is also seen.…”

Endovascular embolisation of an iatrogenic superficial temporal artery pseudoaneurysm using liquid embolic

“…Most cases present with a progressively enlarging pulsatile mass that can present acutely (within days) or months after vessel injury. Though many patients remain otherwise asymptomatic beyond the obvious cosmetic deformity, headache, facial pain, or facial palsy (due to the proximity of the facial nerve in this location) have been reported 4 10 11…”

“…While several imaging modalities exist to aid in establishing a diagnosis—including ultrasound, CT, MRI and diagnostic subtraction angiography—clinical diagnosis based on history and physical examination remains the most useful tool 5 10 12. Differential diagnoses include abscess, arteriovenous fistulae, subcutaneous cysts or vascular tumours.…”

“…As always, care should be taken in this area to avoid injury to the facial nerve during dissection. Additional management modalities include direct injection with thrombin and, for smaller lesions, manual pressure causing thrombosis and ultimately resolution of the pseudoaneurysm 10…”