An overview of the management of pseudoaneurysm of the maxillary artery: A report of a case following mandibular subcondylar osteotomy

• Published in: Journal of cranio-maxillo-facial surgery Vol. 35; no. 1; pp. 52 - 56
• Main Authors: Elton, Victoria J.F, Turnbull, Ian W, Foster, Murray E
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.01.2007; Elsevier
• Subjects: Adult; Aneurysm, False - surgery; arteriovenous fistula; Biological and medical sciences; Bone Remodeling - physiology; Calcinosis - etiology; Carotid Artery, External - surgery; Dentistry; embolization; external carotid artery; Female; haemorrhage; Humans; Ligation; Mandible - surgery; Mandibular Diseases - etiology; mandibular subcondylar osteotomy; maxillary artery; Maxillary Artery - surgery; Medical sciences; Orthopedic surgery; Osteotomy; Otorhinolaryngology. Stomatology; Postoperative Complications; pseudoaneurysm; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; mandibular subcondylar osteotomy; maxillary artery; embolization; ligation; pseudoaneurysm; haemorrhage; arteriovenous fistula; external carotid artery; External carotid; False aneurysm; Osteotomy; Maxillary; Cardiovascular disease; Review; Hemorrhage; Venous disease; Arterial disease; Vascular disease; Surgery; Arteriovenous malformation; Mandible; Stomatology; Instrumentation therapy; Congenital disease; Case study; Arteriovenous aneurysm; Clinical management; Ligature; Embolization
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2006.11.002

Summary Background Aneurysms, pseudoaneurysms, and arteriovenous malformations of the maxillary artery are rare. This is why this case report and current opinions regarding therapy are presented. Patient A 41 year old woman presented in 1991 with recurrent pain and swelling in the right infra-auricular region of 3 years duration which was unresponsive to antibiotics. She had undergone subcondylar osteotomies elsewhere 5 years previously. Imaging revealed a rounded radiolucency of the upper posterior border of the right mandibular ramus with calcification posterior to the radiolucency. The lesion was surgically treated by packing, diathermy and ligation of the external carotid artery and has now resolved completely. Methods for the management of pseudoaneurysms, arteriovenous fistulae and haemorrhage from the maxillary artery include angiography both for initial diagnosis of pseudoaneurysm, arteriovenous malformation and haemorrhage and, if suitable their treatment with endovascular occlusants. The advantages and drawbacks of surgery versus endarterial occlusion are rehearsed. Conclusion Although endovascular intervention has become the first line approach, particulate embolization is more commonly used as a pre-operative technique. Lesions like one described here can of course be managed by surgery alone if sophistizated facilities and skill were not available.