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Case Reports
. 2018 Sep;11(3):219-223.
doi: 10.1055/s-0037-1603454. Epub 2017 May 18.

Lingual Artery Pseudoaneurysm after Severe Facial Trauma

Leyre Margallo  1 , Estibaliz Ortiz de Zárate  1 , Maria Franco  1 , Maria Garcia-Iruretagoyena  1 , Rosa Cherro  1 , Luis Barbier  1 , Josu Mendiola  2 , Thomas Constantinescu  3
Affiliations
Case Reports

Lingual Artery Pseudoaneurysm after Severe Facial Trauma

Leyre Margallo et al. Craniomaxillofac Trauma Reconstr. 2018 Sep.

Abstract

The mortality associated with high-energy trauma has several time peaks and variable prognosis. In the particular case of isolated head and neck trauma, management initially includes stabilizing the patient, especially the airway and circulation, and then proceeding to treat injured structures with debridement and often fracture fixation and coverage. We present a case of a male patient who suffered a severe facial trauma at his workplace. He underwent an initial uneventful emergency surgery for control of bleeding and mandibular osteosynthesis. At 2 weeks postoperatively, a second emergency surgery was required to treat a previously undiagnosed lingual pseudoaneurysm that ruptured spontaneously, with massive oral bleeding. The case highlights the clinical significance and timing of pseudoaneurysm formation, and the surveillance and high index of suspicion required for potentially life-threatening bleeding at later time peaks. Diagnostic and therapeutic angiography effectively treated the late complication. Multidisciplinary management options are reviewed, emphasizing the need for rapid decision making and collaboration to improve outcomes in such significant surgical trauma patients.

Keywords: aneurysm; angiography; facial trauma; false aneurysm; lingual artery; pseudoaneurysm.

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Conflict of interest statement

Conflict of Interest The authors hereby declare that there is no conflict of interest with regard to this study.

Figures

Fig. 1
Fig. 1
( a ) Intraoperative photograph showing a severely comminuted, displaced right mandibular fracture and avulsed teeth. ( b, c ) Volume-rendered and maximum intensity projection unenhanced CT image depicts a comminuted mandibular fracture. There are scattered fragments of mandible.
Fig. 2
Fig. 2
( a ) Lateral projection digital subtraction angiography image demonstrates a right lingual artery aneurysm. ( b ) Volume-rendered and maximum intensity projection CT angiography. On the CT, a vascular mass was identified at the right tongue base arising from the lingual artery.
Fig. 3
Fig. 3
( a ) CT scan after fracture fixation and aneurysm coiling, showing both osteosynthesis and coiling. ( b ) Carotid artery injection after coiling embolization of the right lingual artery aneurysm.
Fig. 4
Fig. 4
Follow-up CT scan at 10 days after aneurysm coiling showing a stable result.
See this image and copyright information in PMC

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