Epistaxis due to traumatic internal carotid artery aneurysm

Epistaxis due to internal carotid artery (ICA) trauma is uncommon, and that due to aneurysm of the artery is rarer still. Most cases result in fatality due to severe, uncontrolled blood loss. The ICA is vulnerable to oropharyngeal trauma as it ascends beside the lateral pharyngeal wall. We describe a case of an 11-month-old girl who sustained oropharyngeal wall trauma from the handle of a wooden spoon. After a characteristic latent period of several days, upper airway obstruction occurred due to a right parapharyngeal mass, which extended inferiorly to the level of the larynx. Angiography confirmed a large dissecting ICA aneurysm. This was treated successfully by radiological coil occlusion.