Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 Jul 22:4:95.
doi: 10.4103/2152-7806.115388. eCollection 2013.

Facial necrosis after endovascular Onyx-18 embolization for epistaxis

Ramesh Grandhi  1 , David Panczykowski, Nathan T Zwagerman, Robin Gehris, Jennifer Villasenor-Park, Jonhan Ho, Lisa Grandinetti, Michael Horowitz
Affiliations
Case Reports

Facial necrosis after endovascular Onyx-18 embolization for epistaxis

Ramesh Grandhi et al. Surg Neurol Int. .

Abstract

Background: Evolution in techniques and equipment has expanded the role, effectiveness, and safety of endovascular transarterial embolization for the treatment of severe epistaxis. Risks from this treatment approach include major ischemic complications. To date, there have been only a few reports of soft tissue necrosis following endovascular embolization for severe epistaxis; none involve the use of Onyx-18.

Case description: We report the case of a 52-year-old woman who presented with epistaxis that was refractory to medical and surgical management, which lead to endovascular intervention and embolization with Onyx-18. The patient subsequently developed nasal ala and facial necrosis as a result of the procedure.

Conclusion: We report the use of Onyx-18 for the endovascular embolization of a patient with severe epistaxis and subsequent complications. In cases of severe epistaxis that warrant intervention in the form of embolization, ischemic complications are rare; however, ischemic complications may be unavoidable and should factor into the discussion regarding procedural risks.

Keywords: Endovascular embolization; Onyx; epistaxis; soft tissue necrosis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(a) Selective catheterization of the external carotid artery to just proximal to the facial artery demonstrates faint Onyx-18 cast of the ipsilateral internal maxillary artery (b) Superselective catheterization of the inferior division of the facial artery using a microcatheter with subsequent Onyx-18 embolization. Onyx-18 cast of the ipsilateral internal maxillary artery is readily visible (c) Superselective catheterization of the superior division of the Facial artery using a microcatheter with subsequent Onyx-18 embolization (d) Nonsubtracted view with roadmap guidance showing Onyx-18 casts within the Internal Maxillary and Facial arteries
Figure 2
Figure 2
Photograph of patient on postembolization day 4, demonstrating hyperpigmented plaque on her left nasal ala and cheek with surrounding erythema
Figure 3
Figure 3
(a) Low magnification hematoxylin and eosin stain of biopsy specimen showing epidermis, dermis, and subcutaneous tissues with dermoepidermal separation (b) Higher magnification demonstrates necrosis of hair follicles (c) Higher magnification demonstrates necrosis of eccrine glands
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Andersen PJ, Kjeldsen AD, Nepper-Rasmussen J. Selective embolization in the treatment of intractable epistaxis. Acta Otolaryngol. 2005;125:293–7. - PubMed
    1. Arat A, Cil BE, Vargel I, Turkbey B, Canyigit M, Peynircioglu B, et al. Embolization of high-flow craniofacial vascular malformations with onyx. AJNR Am J Neuroradiol. 2007;28:1409–14. - PMC - PubMed
    1. Leppanen M, Seppanen S, Laranne J, Kuoppala K. Microcatheter embolization of intractable idiopathic epistaxis. Cardiovasc Intervent Radiol. 1999;22:499–503. - PubMed
    1. Metson R, Hanson DG. Bilateral facial nerve paralysis following arterial embolization for epistaxis. Otolaryngol Head Neck Surg. 1983;91:299–303. - PubMed
    1. Ntomouchtsis A, Venetis G, Zouloumis L, Lazaridis N. Ischemic necrosis of nose and palate after embolization for epistaxis.A case report. Oral Maxillofac Surg. 2010;14:123–7. - PubMed

Publication types