Yang W G, Tsai T R, Hung C C, Tung T C
Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
Ann Plast Surg. 2001 Feb;46(2):159-62. doi: 10.1097/00000637-200102000-00013.
Life-threatening bleeding in facial fractures is considered rare, and most reports do not recommend a precise treatment guideline. Although various methods have been suggested, they are unpredictable in efficacy and may lead to irreversible shock. To avoid irreversible shock, early detection and correct, effective treatment are mandatory. The authors report a patient who presented with a complex midface fracture after falling on June 23, 1999. Life-threatening oronasal bleeding developed 1 hour after arriving at the emergency room. Initial nasal packing failed to stop the nasal bleeding. After resuscitation, the patient's vital signs were stable but bleeding persisted. Angiography showed diffuse extravasation of contrast medium over the territory of the right internal maxillary artery. Embolization was performed successfully to stop the bleeding. The authors review the literature regarding the incidence, diagnosis, and treatment of life-threatening facial fracture. In the literature, the lack of a precise definition leads to various results by various treatments. The authors have formulated a succinct treatment guideline. They favor angiographic embolization as the first choice of treatment when tight nasal and/or oral packing fails.
面部骨折中危及生命的出血被认为较为罕见，大多数报告并未推荐精确的治疗指南。尽管已提出各种方法，但它们的疗效不可预测，且可能导致不可逆的休克。为避免不可逆休克，早期检测以及正确、有效的治疗必不可少。作者报告了一名于1999年6月23日跌倒后出现复杂面中部骨折的患者。到达急诊室1小时后出现危及生命的口鼻出血。最初的鼻腔填塞未能止住鼻出血。复苏后，患者生命体征稳定，但出血仍持续。血管造影显示右颌内动脉供血区域有造影剂弥漫性外渗。成功进行栓塞以止血。作者回顾了有关危及生命的面部骨折的发生率、诊断和治疗的文献。在文献中，缺乏精确的定义导致各种治疗方法产生不同的结果。作者制定了一份简洁的治疗指南。他们赞成在紧密鼻腔和/或口腔填塞失败时，将血管造影栓塞作为首选治疗方法。
