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Case Reports
. 2011:2011:241375.
doi: 10.1155/2011/241375. Epub 2011 Sep 22.

Internal maxillary artery pseudoaneurysm: a near fatal complication of seemingly innocuous pharyngeal trauma

M P Hennus  1 , L Speleman  2
Affiliations
Case Reports

Internal maxillary artery pseudoaneurysm: a near fatal complication of seemingly innocuous pharyngeal trauma

M P Hennus et al. Case Rep Crit Care. 2011.

Abstract

A 2-year-old boy presented with persistent pain and oral blood loss after falling with a toothbrush in his mouth. Initial routine inspection of the oropharynx showed no abnormalities. Recurrent blood loss instigated a reinspection under general anesthesia revealing the head of the toothbrush embedded in the nasopharynx. The toothbrush was removed without problems but several hours later a near fatal rebleeding occurred, requiring aggressive fluid resuscitation. Subsequently, the patient was transferred to our pediatric intensive care unit for further evaluation and treatment. CT angiography (CTA) showed a pseudoaneurysm of the internal maxillary artery which was successfully coiled, and further recovery was uneventful. Pediatric pharyngeal trauma is a common entity with rare, but potentially life-threatening, complications. In case of pharynx lesions, bleeding, and persistent pain, flexible endoscopy by an otolaryngologist is mandatory. In case of persistent bleeding vascular imaging is essential with CTA being a reliable alternative for the more invasive angiography.

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Figures

Figure 1
Figure 1
On the right, pieces of the head of the toothbrush (yellow arrow) immediately after removal from the patients oro-nasopharyngeal junction. On the left, the base of the toothbrush which the patient was found holding after his fall.
Figure 2
Figure 2
CT angiography of the head and neck showing a hematoma shaped like the head of the toothbrush in the right nasopharynx (white arrow) and the aneurysmatic dilatation of the origin of the internal maxillary artery (yellow arrow).
Figure 3
Figure 3
Conventional angiography of the head and neck showing the pseudoaneurysm at the base of the internal maxillary artery (white arrow) and the coil (yellow arrow) closing the pseudoaneurysm successfully.
See this image and copyright information in PMC

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