A rare case report of complications in craniofacial injuries: Cavernous sinus-carotid fistula

Abstract

Rationale: Cavernous sinus-carotid fistula (CCF) is a rare complication of craniofacial injuries in patients receiving oral and maxillofacial surgical care.

Patient concerns: A retrospective review of 15 patients with CCF records was conducted. In addition, we present a rare case of a 32-year-old Chinese woman with CCF receiving oral and maxillofacial surgical care.

Diagnoses: Digital subtraction angiography (DSA) confirmed a diagnosis of CCF.

Interventions: Endovascular surgery was performed via the femoral artery under general anesthesia without any complications.

Outcomes: The postoperative course was uneventful, and the subjective and objective ophthalmic symptoms had resolved.

Lessons: The symptoms of CCF may be delayed for several days or weeks. Thus, maxillofacial surgeons should be aware of this and avoid the untimely repair of facial fractures with potentially disastrous consequences. Interventional neuroradiologic approaches that involve the use of a detachable balloon have made it possible to care for patients with CCF without any complications.

Figure 1

(A) A 32-year-old woman diagnosed with CCF secondary to a motor vehicle accident. DSA view of right internal c. A. revealed laceration in the horizontal segment and associated direct right CCF. (B) Preoperative right vertebral artery injections demonstrating direct CCF development. (C) Two coins embolization of the fistula were performed with preservation of the internal c. A. (D) Posttreatment frontal DSA view of right internal c. A. demonstrating obliteration of the fistula and lack of residual filling. (E) Posttreatment right common c. A. injection revealed lack of residual filling of the fistula. C. A. = carotid artery, CCF = cavernous sinus-carotid fistula, DSA = digital subtraction.