I read with great interest the article by N ardis et al. regarding an uncommon complication following facial trauma. From the title, a reader would have assumed the uncommon complication to be a facial artery pseudoaneurysm as a result of facial trauma.
In my opinion the title of the article is misleading, suggesting that facial trauma is the cause of pseudoaneurysm and not the surgical intervention itself. I understand that facial trauma was the reason for going to operating theatre and if it was not for the facial trauma, the patient would not have undergone a surgical intervention that resulted in the development of a pseudoaneurysm. Contained in the abstract and text, the authors clearly stated that surgical intervention through Risdon or submandibular approach was the cause of facial artery pseudoaneurysm. However, this is not evident in reading the title, ‘Uncommon Complication of Facial Fractures.’
A question not addressed in the article is whether the ligation of the facial artery and vein was required in treating this fracture. E llis and Z ide state that when approaching mandible posterior to the premasseteric notch, the vascular structures are often not encountered or can be preserved by anterior retraction. When approaching the area anterior to the premasseteric notch, the facial artery and vein should be ligated and transected. There is little harm in ligating these vessels as there is sufficient collateral circulation in the face.
In my practice it is common to ligate both facial artery and vein when approaching mandibular angle or subcondylar fracture through submandibular approach in order to facilitate access to the fracture. By ligating the facial artery and vein, one has greater exposure and less retraction and tension on the tissues which could cause blunt trauma to the facial vessels and thus a pseudoaneurysm formation.