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Abstract
Introduction An 83-year-old patient presents with a maxillofacial traumatic injury involving a comminuted fracture of the right zygomatic complex. Upon emergency CTA, a 55/36 mm hematoma with active bleeding areas in the naso-maxillary region is identified, causing a mass effect on neighboring structures. Suspicion of a pseudoanurysm arising from a branch of the maxillary artery is made. The maxillofacial surgery treatment option would have been extreme, involving ligation of the external carotid artery. Therefore, endovascular treatment was decided.
Case Description Decision for angiography and further embolization is made. Upon injection of the right external carotid and subsequent microcatheterization of the right maxillary artery, active extravasation of contrast is noted at the level of the pseudoaneurysm, originating from one of its branches. Glue (Magic Glue BALT®) was used for embolization of the respective branch, avoiding embolization of other proximal branches and the middle meningeal artery. As previously described in the literature the non-target embolisation of the infraorbital artery was expected without any complications or symptoms.
Results Immediately after the endovascular procedure and embolization, the patient was stable with no further bleeding or growth of the pseudoaneurysm and was monitored, with indication for a follow-up CTA. At three week CTA the pseudoaneurysm reduced its volume from 55x36 mm to 36x27 mm in axial plane, with a significantly reduced volume of hyperdense areas. We highly recommend this method of glue embolization when dealing with pseudoaneurysms arising from the maxillary artery, that are not feasible for surgical treatment.
