Madani Mansoor, Veznedaroglu Erol, Pazoki Alex, Danesh Joseph, Matson Scott L
Department of Oral and Maxillofacial Surgery, Capital Health System, Trenton, New Jersey, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Nov;110(5):579-84. doi: 10.1016/j.tripleo.2010.03.021. Epub 2010 Jun 26.
Pseudoaneurysms, or arteriovenous fistulas, of the extracranial arterial system, particularly the facial artery, are rare. Its occurrence after reconstructive facial surgery has been reported rarely in the literature. In this article we describe a rare case of pseudoaneurysm developing over 4 weeks after an uneventful Le Fort I maxillary osteotomy, sagittal split osteotomy, and advancement genioplasty. A 22-year-old man presented with a severe class III skeletal deformity, mandibular hyperplasia, and maxillary hypoplasia. The patient's immediate postoperative course was uneventful for a 2-week period after surgery. Then the patient, while at home, experienced an accidental injury to his jaw and started to bleed from his left retromandibular side. He was taken to a local hospital where his bleeding was controlled by topical coagulant and pressure. During this short hospital visit he was given 3 units of blood and was subsequently discharged. He had no further bleeding and was monitored on a regular basis. One month after his double jaw surgery and 2 weeks after his bleeding episode, the left facial swelling diminished in size but was still visible. This mass was soft and pulsatile with a palpable thrill and auditory machinery murmur on auscultation. Although the patient was totally asymptomatic at this time, he was sent to the emergency room for a computerized tomography scan with 3-dimensional reconstruction. A Doppler ultrasound was also ordered. The ultrasound revealed the mass to be a pseudoaneurysm. Angiography revealed a pseudoaneurysm of the left facial artery. Coil embolization of the left facial artery was performed with a Cordis Trufill complex coil. The patient tolerated the procedure well and a repeat angiogram demonstrated no further evidence of aneurysm, arteriovenous malformation, vasospasm, or feeding branches to the fistula. The patient made an uneventful recovery and was discharged the day after the procedure. In this article, we review the anatomy of the extracranial arterial system of the head and neck, discuss the pathogenesis and clinical presentation of pseudoaneurysm, and present diagnostic imaging and treatment options for pseudoaneurysms of the face.
颅外动脉系统的假性动脉瘤或动静脉瘘，尤其是面动脉的此类病变较为罕见。文献中鲜有关于其在面部重建手术后发生的报道。在本文中，我们描述了一例罕见的假性动脉瘤病例，该病例发生在顺利完成勒福Ⅰ型上颌骨截骨术、矢状劈开截骨术和前移颏成形术后4周。一名22岁男性，患有严重的Ⅲ类骨骼畸形、下颌骨增生和上颌骨发育不全。术后2周内患者的近期术后过程平稳。之后患者在家中时，下颌意外受伤，左侧下颌后缘开始出血。他被送往当地医院，在那里通过局部凝血剂和压迫控制了出血。在这次短暂的住院期间，他接受了3单位的输血，随后出院。他没有再次出血，并接受定期监测。双颌手术后1个月，出血事件发生2周后，左侧面部肿胀有所减小，但仍可见。该肿块质地柔软且有搏动，触诊时有明显震颤，听诊时有血管杂音。尽管此时患者完全无症状，但仍被送往急诊室进行三维重建计算机断层扫描。还安排了多普勒超声检查。超声显示该肿块为假性动脉瘤。血管造影显示左侧面动脉假性动脉瘤。使用Cordis Trufill复合线圈对左侧面动脉进行了线圈栓塞。患者对该手术耐受良好，再次血管造影显示无动脉瘤、动静脉畸形、血管痉挛或瘘管供血分支的进一步证据。患者恢复顺利，术后第二天出院。在本文中，我们回顾了头颈部颅外动脉系统的解剖结构，讨论了假性动脉瘤的发病机制和临床表现，并介绍了面部假性动脉瘤的诊断性影像学检查和治疗选择。
