顔面多発骨折に伴う出血に対して外頸動脈分枝の動脈塞栓術が有効であった1例

• Published in: 日本口腔外科学会雑誌 Vol. 55; no. 8; pp. 415 - 418
• Main Authors: 西川, 健, 村木, 祐孝, 藤田, 弥千, 大谷, 泰志, 吉岡, 泉, 冨永, 和宏
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.08.2009
• Subjects: 出血; 動脈塞栓術; 外傷; 外頸動脈分枝; 顔面多発骨折
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.55.415

We report a case of hemorrhage due to a panfacial fracture that was successfully treated by embolization of the branches of the external carotid artery. A 39-year-old man had a traffic accident while intoxicated and was admitted to the emergency department. The clinical diagnosis included a panfacial fracture（Le Fort Ⅰ, Ⅱ, Ⅲ, and right mandibular body and symphysis fractures）with associated fractures of the limbs and other bones. The patient had a massive hemorrhage from the oral and nasal cavities. The hemorrhage was controlled temporarily by application of pressure. Dental impressions were taken to prepare for surgical fracture fixation. Immediately after impression taking, hemorrhage from both the nasal cavities and the posterior portion of the maxilla recurred. We attempted to induce hemostasis by gauze packing and Bellock tamponade repeatedly, but complete hemostasis was difficult to achieve. Therefore, embolization of the branches of external caroid artery was performed bilaterally, using the Seldinger technique. Complete hemostasis was achieved after embolization, and the operation was performed at a later date.