Three cases of organized hematoma of the maxillary sinus in patients who underwent preoperative arterial embolization

Abstract

Organized hematoma (OH) is benign tumor in the maxillary sinus. The standard treatment for OH is complete surgical resection, however massive bleeding can occur during the procedure, albeit rarely. Some reports have suggested preoperative embolization is useful for reducing the volume of intraoperative bleeding. We report 3 cases of OH in the maxillary performed preoperative embolization. We identified the feeding arteries by angiography or IVR-CT, and we embolized them using Gelatin sponge particles. The embolized artery was the maxillary artery or both the maxillary and the facial artery. There were no major complications as a result of embolization. The mean fluoroscopy time was 35.8 minutes, and the mean fluoroscopy dose was 329.3 mGy. Tumor resection was performed the next day after arterial embolization. The mean bleeding volume for surgery was 383.3 ml, and the mean operative time was 194 minutes. No recurrence was observed in any of the cases over a 4-year follow-up period. We considered that it is possible that preoperative artery embolization is useful for decreasing intraoperative bleeding volume. Although the methods and usefulness of embolization await future reports, it is a technique that should be considered preoperatively because of its potential to prevent massive bleeding.

Keywords: Interventional Radiology; Intraoperative Bleeding; Maxillary Sinus; Organized Hematoma; Preoperative Embolization.

Fig. 1

CT and MRI images of Case 1. (A) Axial non-contrast CT image shows a soft-tissue mass with a higher CT value than muscle. (B) Axial bony algorithm CT image shows smooth bone erosion associated with OH. (C) Axial contrast CT image shows slight enhancement. (D, E) Axial T1WI and T2WI demonstrates a heterogeneous signal. (F) Axial contrast Fat−Saturation T1WI shows uneven enhancement

Fig. 2

Angiography images of Case 1. (A) Lateral view of DSA (Digital subtraction angiography) image shows maxillary artery distal to the middle meningeal artery (MMA). It is considered to be the feeding artery of OH. Arrow demonstrates the catheter tip position. (B) Lateral view of DSA image shows the embolized OH artery. Arrow demonstrates the catheter tip position and arrowhead demonstrates MMA

Fig. 3

Macroscopic and microscopic findings of organized hematoma in Case 1. (A) The resected specimen mainly showed dark red appearance, suggesting old hematoma. The lesion was partially covered with white shell, suggesting organized fibrous tissue. (B) Microscopically, the lesion contain old red blood cells (right upper side), old fibrin exudation (right lower side) and dense collagen fiber (left side). No tumor cells were found