CASE REPORTS   

Journal of Maxillofacial Trauma 2013 April;2(1):26-31

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Brisk posterior maxillary hemorrhage during a LeFort 1 open reduction. Interventional neuroradiology catheter embolization of the bilateral internal maxillary arteries. A case report and review of literature

Li P. ¹, Oh S. ¹, Koenigsberg R. ², Abaza N. ¹

¹ Division of Oral and Maxillofacial Surgery Department of Surgery, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA; ² Division of Interventional Radiology Department of Radiology Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA

This is a case report of a patient who benefited from interventional neuroradiology (INR) embolization when experiencing brisk hemorrhage originating from the posterior maxilla during open reduction of a traumatic LeFort 1 fracture with bilateral comminuted pterygoid plates. Achieving hemostasis posterior to the maxilla poses significant challenge to maxillofacial surgeons due to the limited access and the difficulty of the visualization of the bleeding source, thus, sometimes necessitating maxillary down-fracture, with its associated morbidities. Whether it is orthognathics, pathology, or maxillofacial trauma, conventional surgical ligation of the internal maxillary artery (IMA), or branches of, is demanding, and may result in significant morbidity or mortality if hemorrhage is not controlled. With advancements in modern medicine, INR catheter embolization may be of vital importance, even life saving, for patients who experience hemorrhage in the posterior maxilla. The current literature on INR in maxillofacial trauma is limited. This paper will review and emphasize on the importance of pre-operative analysis of radiographic studies and its vital role in planning for surgery. Additional methods to achieve surgical hemostasis will be discussed.