A case of bleeding from maxillary carcinoma embolized from the maxillary and ophthalmic arteries

The majority of maxillary sinus cancers are advanced at initial detection due to anatomical limitations and lack of early symptoms. In patients with orbital invasion, the feeding arteries of the tumor are often associated with the ophthalmic artery in addition to the maxillary artery. We describe a case of tumor bleeding in a patient with recurrent maxillary carcinoma that was treated with embolization from the maxillary and ophthalmic arteries.

A 70-year-old man was treated for left maxillary carcinoma from the maxillary artery with 6 cycles of selective intra-arterial cisplatin infusion with concomitant radiation therapy. He subsequently had epistaxis and underwent arterial embolization for hemostasis. He had almost no sight by this time. Angiography of the left external carotid artery and internal carotid artery revealed blood supply from the maxillary and ophthalmic arteries. Regarding the maxillary artery, coil embolization was performed after embolization with 300-500 μm Embosphere. On the other hand, for the ophthalmic artery, the 3rd portion, supratrochlear artery and dorsal nasal artery, were selected and embolized with coils. Final angiography revealed disappearance of tumor staining and a residual choroidoretinal blush. There was no bleeding that needed treatment up to 2 months after embolization.

In embolization of the ophthalmic artery, it is necessary to embolize the second and subsequent parts because the arteries associated with visual function branch off from the first part. Even in patients whose visual acuity has been almost lost, like in this case, there is a risk of eye pain from embolization at the proximal end, and distal embolization is necessary.