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Traumatic Carotid-Cavernous Fistula in a Child with Nasal Penetrating Injury
Hamidreza Hasani1, Mohammad Ghorbani2, Sima Sheikhghomi3
1Department of Ophthalmology, Madani hospital, Alborz University of Medical Sciences, Karaj, Iran.
Insights
A rare carotid-cavernous fistula (CCF) in a child, caused by penetrating facial trauma, was successfully treated with embolization and stenting. Early recognition of this uncommon complication is vital for preventing vision and neurological damage.
Area of Science:
- Pediatric Ophthalmology
- Craniofacial Trauma
- Vascular Surgery
Background:
- Traumatic penetrating carotid-cavernous fistula (CCF) is a rare complication of craniofacial trauma in children.
- Prompt diagnosis and management are crucial to prevent permanent visual and neurological deficits.
Purpose of the Study:
- To report a case of direct CCF in a pediatric patient following penetrating nasal injury.
- To emphasize the importance of high clinical suspicion for CCF in pediatric patients with atypical orbital signs after facial trauma.
Main Methods:
- A 2.5-year-old boy with a screwdriver-induced nasal injury presented with epistaxis, proptosis, chemosis, and restricted ocular motility.
- Initial imaging was inconclusive, and orbital cellulitis was suspected.
- Digital subtraction angiography (DSA) confirmed a direct (Type A) CCF, followed by endovascular embolization and internal carotid artery (ICA) stenting.
Main Results:
- Successful endovascular embolization and ICA stenting were performed.
- The patient's condition was managed effectively, highlighting the success of the chosen treatment modality.
Conclusions:
- This case underscores the necessity of considering CCF in pediatric patients with orbital symptoms after facial trauma, even with non-specific initial findings.
- A high index of suspicion and timely diagnostic angiography are key for appropriate management of pediatric CCF.
Background:
Traumatic penetrating carotid-cavernous fistula (CCF) is an uncommon complication of craniofacial trauma, particularly in pediatric patients. Prompt recognition is essential to prevent irreversible visual and neurological deficits.
Case Presentation:
We describe a 2.5-year-old boy who sustained a penetrating nasal injury caused by a screwdriver. He initially presented with epistaxis and subsequently developed left-sided proptosis, chemosis, and restricted ocular motility. Early imaging studies were inconclusive, and orbital cellulitis was initially suspected.
Diagnosis And Management:
A delayed diagnosis of a direct (Type A) CCF was ultimately confirmed using digital subtraction angiography (DSA). The patient underwent successful endovascular embolization combined with internal carotid artery (ICA) stenting.
Conclusion:
This case highlights the need for a high index of suspicion for CCF in children presenting with atypical orbital findings following facial trauma, even when initial imaging doesn't reveal definitive pathology.
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Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...