Embolization for treating posttraumatic pseudoaneurysm of the sphenopalatine artery

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Radiology

Background:

• Posttraumatic pseudoaneurysms of the sphenopalatine artery are exceptionally rare vascular injuries.
• Zygomaticomaxillary complex fractures, particularly those involving pterygoid plates, pose a risk to adjacent vasculature.
• Massive or persistent nasopharyngeal bleeding following maxillofacial trauma warrants thorough vascular investigation.

Observation:

• Two patients presented with massive initial nasal bleeding, followed by persistent nasopharyngeal hemorrhage after zygomaticomaxillary complex fracture reduction.
• Angiography revealed pseudoaneurysms of the sphenopalatine artery as the source of intractable bleeding.
• The sphenopalatine artery's proximity to the pterygoid plates makes it vulnerable during complex facial fractures.

Findings:

• Endovascular embolization successfully achieved hemostasis in both patients with sphenopalatine artery pseudoaneurysms.
• Recurrent bleeding after maxillofacial trauma or surgery can indicate injury to deeply located arteries.
• Early diagnostic angiography is recommended for suspected vascular injuries in patients with persistent bleeding.

Implications:

• This case series highlights the importance of considering sphenopalatine artery pseudoaneurysms in the differential diagnosis of post-traumatic epistaxis.
• Prompt imaging and endovascular intervention are critical for managing life-threatening hemorrhage from these rare injuries.
• Awareness of potential vascular complications associated with zygomaticomaxillary complex fractures can improve patient outcomes.