The Usefulness of Transcatheter Arterial Embolization for Panfacial Injury
Hwan-Jun Choi, MD, Chang-Yong Choi, MD, and Hyung-Eun Yang MD
: A life-threatening hemorrhage resulted from severe facial fracture is rare, but it needs a prompt and aggressive treatment. Especially, a massive oronasal bleeding combined with midfacial fracture may resulted from rupture of internal maxillary artery(1-4). As a radiologic intervention has developed recently, its use has increased for managing this case. We reviewed its usefullness with our experiences and literatures.
METHOD: A retrospective review was performed to determine the usefulness of transcatheter arterial embolization(TAE) in patients with panfacial trauma. The protocol was abandoned for any patients who became profoundly hypotensive (with systolic blood pressure 60 mmHg or lower) during CT or angiography. If the vital signs were unstable, cardiopulmonary resuscitation was performed. Then we did nasal packing and electrocautery for oronasal bleeding and checked all injured region by radiologic study including CT. If oronasal bleeding was persistent although primary management, radiologic intervention was performed. Angiography showed diffuse extravasation of contrast medium over territory of the injuried internal maxillary artery. TAE was performed when angiography showed arterial extravasation. 10 patients got TAE and bleeding focus could be controlled by embolization with polyvinyl alcohol and gelfoam (Figure 1).
RESULTS: Between January 2005 and December 2006, 10 patients with panfacial injuries underwent TAE immediately after admission. 5 patients had basal skull fracture, 7 patients had intracranial hemorrhage, and 4 patients had intra-abdominal or thoracic injuries. 5 patients had Bilateral Lefort II fracture, 3 patients had Bilateral Lefort III fracture, 1 patient had Lefort IV fracture, and 1 patient had Lefort I and communited mandibular fracture. After intervention, the vital signs became stable and there was no complications from embolization on follow-up for 6 months. Also patients could recover through appropriate operation.
CONCLUSION: These findings, illustrate the need for prompt identification and proper management of the associated life-threatening injuries in panfacial fracture patients. TAE for maxillofacial injury has many advantages for doctor and patient. First, it hurts less than a compression device or operation, which are other ways to treat oronasal bleeding. Second, it doesn't need a general anesthesia. And through a single procedure not only we can know an accurate bleeding point, but also we can stop bleeding by embolization.
Fig 1. A 66-years-old man was injured by motorcycle accident. He had a severe oronasal bleeding and LeFort II fracture. Pre-embolization angiography(left) and post-embolization angiography(right).
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