Pseudo-aneurysm of the posterior auricular artery after oncological neck dissection

Pseudo-aneurysm of the posterior auricular artery after modified radical neck dissection is an extremely rare and potentially life-threatening complication. To our knowledge, this is the first reported case of post-neck dissection pseudoaneurysm presenting with bleeding from the orifice of Stensen's duct. A 46-year-old man underwent right submandibulectomy and modified radical neck dissection for carcinoma ex pleomorphic adenoma with cervical lymph node metastasis. On postoperative day 14, the patient presented with sudden and persistent intraoral bleeding. Examination revealed active bleeding from the orifice of the right Stensen's duct. Routine coagulation tests were within normal limits, and no coagulopathy was identified. Initial management for suspected parotid fistula was ineffective. Contrast-enhanced computed tomography showed a well-defined enhancing lesion in the parotid gland. Digital subtraction angiography confirmed a pseudo-aneurysm arising from the right posterior auricular artery. Successful superselective endovascular embolization was performed using platinum coils. The patient recovered uneventfully and remained free of recurrence or sequelae during 3 years of follow-up. This case emphasizes the importance of early recognition and urgent endovascular management for this rare complication.