Carotid-Cavernous Fistula as a Complication of Panfacial Fracture: Case Report 11 Years after the Surgery

Abstract

The carotid-cavernous fistula (CCF) is a rare complication in patients victimized by craniofacial trauma. It involves multidisciplinary medical action. Owing to its potential complications, it is essential that maxillofacial surgery and neurosurgery specialists diagnose this condition so that appropriate treatment can be performed. The authors present a report of a case 11 years after the surgery.

Keywords: Dandy triad; carotid-cavernous fistula; cavernous sinus; facial trauma.

Fig. 1

Patient's photos after hospital admission.

Fig. 2

(a–d) CT windows displaying multiple fractures in the middle third of the face or midface.

Fig. 3

CT windows displaying multiple fractures in the lower third of the face or mandibular region.

Fig. 4

CT windows with arrows highlighting fractures to the sphenoidal sinus.

Fig. 5

(a–d) Stages of three-dimensional reconstruction of the face, using stable skeleton fixation by means of titanium plates and screws.

Fig. 6

(a, b) Patient's appearance on the 15th postoperative day, start of carotid-cavernous fistula signs and symptoms.

Fig. 7

Right side angiography, with coronal and normal views.

Fig. 8

(a, b) Left side angiography, with coronal view, showing congestion toward the left orbit.

Fig. 9

(a) Left side angiography, with coronal view, showing congestion toward the left orbit. (b) The same coronal view with occluded fistula—arrow no. 1 highlights the activated balloon and arrow no. 2 highlights the microcatheter. (c, d) Left side angiography, with sagittal view showing the detachable microcoils used for permanent carotid-cavernous fistula occlusion (arrows).

Fig. 10

(a–d) Patient 1 year postsurgery, with good appearance, normal ocular movements, and no other problems.

Fig. 11

(a–d) Patient 11 years postsurgery, with no residual deformity.

Fig. 12

(a–c) Eleven years postsurgery examination. Three-dimensional reconstruction showing good structural results.

Fig. 13

Eleven years postsurgery examination. CT highlighting the position of detachable microcoils used to treat carotid-cavernous fistula on the left side. (a) CT in axial view; (b) CT in coronal view; (c) CT in sagittal view.