Carotid-cavernous fistula: a complication of maxillofacial trauma

Abstract

Fistulas of the internal carotid-cavernous sinus are an unusual arteriovenous malformation. Two types exist: (1) spontaneous fistulas and (2) traumatic fistulas. This paper deals with the traumatic variety which is seen more commonly in men as a direct result of severe maxillofacial injury. Recent anatomic studies are correlated with the physical findings associated with carotid-cavernous fistula, ie, headache, chemosis, exophthalmos, pulsatile bruit, and multiple cranial nerve paralyses. A case report illustrates these findings. The differential diagnosis which varies from tumors, to cavernous sinus thrombosis, to intraorbital aneurysm is discussed. The role of angiography in diagnosis is described. Present management consists of intracranial ligation of the internal carotid artery with use of a muscle embolus to occlude the fistula and selective ligation of the cervical carotid.