Margallo Leyre, Zárate Estibaliz Ortiz de, Franco Maria, Garcia-Iruretagoyena Maria, Cherro Rosa, Barbier Luis, Mendiola Josu, Constantinescu Thomas
Department of Oral and Maxillofacial Surgery, Hospital Universitario Cruces, BioCruces Health Research Institute, Bizkaia, Spain.
Department of Radiology, Hospital Universitario Cruces, BioCruces Health Research Institute, Bizkaia, Spain.
Craniomaxillofac Trauma Reconstr. 2018 Sep;11(3):219-223. doi: 10.1055/s-0037-1603454. Epub 2017 May 18.
The mortality associated with high-energy trauma has several time peaks and variable prognosis. In the particular case of isolated head and neck trauma, management initially includes stabilizing the patient, especially the airway and circulation, and then proceeding to treat injured structures with debridement and often fracture fixation and coverage. We present a case of a male patient who suffered a severe facial trauma at his workplace. He underwent an initial uneventful emergency surgery for control of bleeding and mandibular osteosynthesis. At 2 weeks postoperatively, a second emergency surgery was required to treat a previously undiagnosed lingual pseudoaneurysm that ruptured spontaneously, with massive oral bleeding. The case highlights the clinical significance and timing of pseudoaneurysm formation, and the surveillance and high index of suspicion required for potentially life-threatening bleeding at later time peaks. Diagnostic and therapeutic angiography effectively treated the late complication. Multidisciplinary management options are reviewed, emphasizing the need for rapid decision making and collaboration to improve outcomes in such significant surgical trauma patients.
高能创伤相关的死亡率有多个高峰且预后各异。在单纯头颈部创伤的特定情况下，初始处理包括稳定患者状况，尤其是气道和循环，然后进行清创治疗损伤结构，常需进行骨折固定和创面覆盖。我们报告一例男性患者，他在工作场所遭受了严重面部创伤。他接受了初步的急诊手术以控制出血和下颌骨接骨术，手术过程顺利。术后2周，因先前未诊断出的舌部假性动脉瘤自发破裂并导致大量口腔出血，需要进行第二次急诊手术。该病例突出了假性动脉瘤形成的临床意义和时间点，以及对后期可能危及生命的出血进行监测和高度怀疑的必要性。诊断性和治疗性血管造影有效地治疗了晚期并发症。本文回顾了多学科管理方案，强调在此类重大手术创伤患者中快速决策和协作以改善预后的必要性。
