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Ruptured Internal Maxillary Artery Pseudoaneurysm Following Lefort I Osteotomy: Case Report, Treatment, Review of The Literature, and Evidence-Based Guidelines
Michael R. Bykowski, Amber L. Hill, William Tobler, Catherine Garland, Renata Maricevich, Jesse A. Goldstein
University of Pittsburgh Medical Center, Department of Plastic Surgery
2016-02-03
Presenter: Michael R Bykowski
Affidavit:
The work from this proposal was carried out in majority by the presenting author.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: LeFort I osteotomy is a commonly performed procedure to correct dentofacial deformities, but the treatment and guidelines for surveillance are unclear. The purpose of this report is to discuss a clinical case of ruptured internal maxillary (IMAX) artery pseudoaneurysm (PA) following a LeFort I osteotomy and to review the literature and provide evidence-based guidelines for surveillance.
Methods: We present a case of a 27 year-old male (K.D.) who was born with left unilateral complete cleft lip and palate who previously underwent multiple craniofacial procedures, including LeFort I. The patient underwent a repeat LeFort I osteotomy and maxillary advancement.
Results: On postoperative days #15 and #20, K.D. suffered episodes of small volume epistaxis that resolved spontaneously. On postoperative day #24 a larger volume episode occurred, which resolved with nasal packing with vasoactive agent. On postoperative day #36, K.D. presented to the hospital with a large volume episode of epistaxis accompanied by presyncope, emesis, tachycardia, and hypotension and required blood transfusion. CT angiography demonstrated a traumatic pseudoaneurysm of the distal IMAX artery, which was treated by coil embolization.
Conclusions: Postoperative pseudoaneurysm of the IMAX artery presented with progressively larger volumes of epistaxis after an initial postoperative period with minimal epistaxis. While pseudoaneurysm of the IMAX artery is rare following LeFort I osteotomy, it should be considered as an etiology for persistent epistaxis following recent orthognathic surgery. Furthermore, review of the literature suggests that minor bleeding >2 weeks after surgery warrants imaging for investigation of this potentially life-threatening complication.
