Treatment of Pseudoaneurysm of Internal Maxillary Artery: A Case Report

Abstract

Pseudoaneurysms are rare lesions secondary to blunt or penetrating trauma, temporomandibular joint surgery, or orthognathic surgery. Nonsurgical interventions are the treatment of choice for pseudoaneurysms. In the case reported here, endovascular injection of acrylic glue was successful in the treatment of a pseudoaneurysm of the internal maxillary artery secondary to fracture of the zygomatic bone.

Management of Hemorrhagic Pseudoaneurysmal Arteriovenous Fistula of the Sphenopalatine Artery

“…A pseudoaneurysm which is essentially a contained hematoma that communicates with the intravascular space occurs after rupture of the endothelium and with blood leakage into and external to the damaged vascular wall. A fragile vulnerable fibrous connective tissue wall forms around the hematoma in 1 to 8 weeks [16]. Irradiation-induced arterial rupture occurs usually within months following treatment and may occur even after a more prolonged period [17].…”

“…Advanced MR and CT angiographic techniques may allow for the identification of the pathology that incites the blood, that is, fracture or tumor. These noninvasive diagnostic imaging modalities are limited in evaluating the specific angioarchitecture and delay therapeutic intervention in life-threatening hemorrhages [7, 16]. …”

“…Endovascular embolization of internal maxillary artery and related distal branch vessel pseudoaneurysms is favored over surgery because of anatomic and operative complexities [16]. Embolization with various agents to address ruptured and unruptured pseudoaneurysms of the internal maxillary artery has been described [3, 13, 15, 18].…”

“…Embolization with various agents to address ruptured and unruptured pseudoaneurysms of the internal maxillary artery has been described [3, 13, 15, 18]. Descriptions of acrylic liquid embolic agent use in the management of pseudoaneurysms without arteriovenous fistula consequent to acute trauma, surgical injury, and radiotherapy of the external carotid artery have been reported [16, 19, 20]. There are no reports describing the use of n-BCA embolization of the sphenopalatine artery for the endovascular management of active oronasal bleeding from a fistulous pseudoaneurysm.…”

Non-pulsatile traumatic pseudoaneurysm of the internal maxillary artery following trauma to mandible

“…Gradually expanding, the lesion may rupture and trigger severe haemorrhage or thromboembolism. Most commonly, it manifests as a delayed painful swelling associated with asymmetries and neurological deficits [2,3]. Imaging such as angiogram, ultrasound, computed tomography (CT) scan and magnetic resonance may be used to facilitate in identifying pseudoaneurysm.…”