Pseudoaneurysm of the Pterygoid Artery After a Gunshot to the Face

A 39-year-old male presented to our institution after sustaining a gunshot wound to the face. He was initially unresponsive with bleeding from the nares bilaterally and was intubated for airway protection. A computed tomography angiogram of the head and neck demonstrated multiple foci of active extravasation in the left maxillary sinus. The patient was taken for emergent neuroendovascular intervention, during which a large, 6.1 mm × 6.4 mm pseudoaneurysm of the left pterygoid artery was discovered and embolized with Onyx liquid embolic agent, with subsequent complete obliteration of the pseudoaneurysm. Embolization immediately halted the bleeding. The patient was neurologically intact at his most recent follow-up appointment. This case demonstrates the importance of obtaining an emergent computed tomography angiography for patients with ballistic facial trauma and early involvement of endovascular neurosurgery for treatment of intractable sinonasal bleeding.