Life-threatening hemorrhage after zygomatic bone surgery. About 2 posttraumatic cases

Area of Science:

• Maxillofacial Surgery
• Vascular Surgery
• Trauma Management

Background:

• Management of zygomatic bone fractures involves balancing operative vs. conservative treatments, with significant consideration for hemorrhagic complications.
• Maxillofacial surgeons must identify and manage life-threatening hemorrhage associated with these fractures.
• Zygomatic fractures present complex challenges in surgical timing and approach.

Observation:

• Two cases of massive hemorrhage following zygomatic fracture surgery are presented.
• Hemorrhage occurred in both early and delayed surgical interventions.
• Pseudoaneurysms of external carotid artery branches were identified as the source of bleeding via angiography.

Findings:

• Selective embolization of external carotid artery branches rapidly controlled bleeding in both cases.
• Angiography is crucial for diagnosing pseudoaneurysms in post-traumatic hemorrhage.
• Embolization offers an effective alternative to surgical intervention for controlling pseudoaneurysm rupture.

Implications:

• Selective embolization is a viable "damage control" strategy for life-threatening hemorrhage from ruptured pseudoaneurysms.
• This approach can be crucial in managing severe bleeding post-zygomatic fracture surgery.
• Understanding the risk of pseudoaneurysm formation is vital for surgical planning and patient safety.