[Traumatic carotid-cavernous aneurysm after removal of cancer of the upper jaw: a case report].

A case of a traumatic carotid-cavernous aneurysm after removal of cancer of the upper jaw was reported. A 63-year-old male complaining of massive epistaxis from the left nostril was admitted to our clinic. He had suffered from cancer of the left upper jaw and had been treated with radical operation. During the surgical procedure, massive bleeding which was considered to be from the left internal carotid artery, suddenly occurred. The hemorrhage was somehow controlled by packing with oxidized cellulose. He experienced recurrent massive epistaxis after admission. Cerebral angiograms revealed an anterior-medially projecting aneurysm arising from the cavernous portion of the left internal carotid artery. He had a good cross circulation from right to left on compression of the left carotid artery. This aneurysm at the carotid-cavernous portion was produced as a result of injury during an operation for cancer of the upper jaw. To prevent disastrous bleeding from the aneurysm, the aneurysm was then successfully treated by the trapping of extra-and intracranial carotid ligation in combination with left STA-MCA anastomosis. There was no recurrence of epistaxis after the operation. However, a low-grade fever persisted before operation and a blood culture showed MRSA sepsis after the operation. Intensive chemotherapy was performed for this MRSA sepsis, he died of the accompanying DIC. Although aneurysmal epistaxis following a severe closed head trauma is a well-known phenomenon, an iatrogenic carotid-cavernous aneurysm presenting with recurrent massive epistaxis is rare. Several comments were made about the iatrogenic carotid cavernous aneurysm, and the necessity of early diagnosis and treatment was emphasized.