Embolization of pseudoaneurysm of the sphenopalatine artery after orthognathic surgery

In orthognathic surgery, Le Fort I osteotomy is one of the most used methods for correction of dental-facial deformities and is considered a secure procedure. However, this procedure may lead to various complications, including uncommon vascular complications. We describe a case of late development of a pseudoaneurysm in a branch of the maxillary artery in a patient 20 years old who had undergone bimaxillary surgery at Hospital São Lucas. Pseudoaneurysm is caused by an incomplete injury to the blood vessel with rupture of one or more layers of the vessel wall rather than the rupture of all layers. Pseudoaneurysm of the external carotid artery or its branches is rare. In clinical evaluation the patient denied routine use of medication, alcohol, tobacco or illicit drugs. Nine weeks after surgery returned with swelling in his left cheek, pain at palpation, and complaining of nasal bleeding in the last 24 h. Nasal packing was performed and an angiography by CT with contrast revealed a lesion measuring 2 mm × 2 mm in the left sphenopalatine artery. After 48 h another episode of epistaxis aggravated the injury which increased to 13 mm in length after further examination. The patient underwent emergency embolization with microcoils in the sector of Neuroradiology at Santa Casa de Misericordia. Treatment showed resolution of the lesion without side effects and no recurrence during the postoperative follow-up of 15 months. Among the main forms of treatment of vascular lesions, embolization demonstrates to be a technically safe procedure with few complications.

Conflict of interest: None declared.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Embolization of pseudoaneurysm of the sphenopalatine artery after orthognathic surgery
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