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Management of pseudoaneurysms of the internal maxillary artery derived from orthognathic surgery based on one case

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Abstract

Purpose

The purpose of this article is to highlight the risk of pseudoaneurysms formation after orthognathic surgery, their clinical features and management.

Methods

A case report of a 24-year-old man who suffered a pseudoaneurysm of the internal maxillary artery after sagittal osteotomy during orthognathic is reported. After three bleeding episodes, a pseudoaneurysm was diagnosed with a computed tomography angiogram (CTA) and treated with an embolization of the internal maxillary artery with polyvinyl alcohol (PVA) successfully.

Results

Pseudoaneurysms derived from the external carotid artery are an uncommon complication of orthognathic surgery, especially related to sagittal osteotomy instead of LeFort I osteotomy.

Conclusion

Pseudoaneurysms derived from external carotid artery branches must be suspected when patients show multiple episodes of bleeding (epistaxis or through the surgical approach) within the first two weeks after orthognathic surgery. If so, vascular CT or angiography should be performed to rule out the presence of vascular injuries. In case a pseudoaneurysm is identified, vascular embolization with N-butyl-cyanoacrylate seems to be the best treatment if available. If this treatment is not available or bleeding cannot be controlled, surgical ligature of the injured vessel is a valid treatment.

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Author information

Authors and Affiliations

  1. Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain

    Gonzalo Botella-Casas, Mariano Marqués-Mateo, Luis Miragall-Alba & Daniela María Río-Vega

  2. Department of Anatomy and Embryology, University of Valencia, Valencia, Spain

    Eva González-Soler

  3. Head of Service of Maxillofacial Surgery, Hospital Clinico Universitario of Valencia, INCLIVA, Valencia, Spain

    Miguel Puche-Torres

Authors
  1. Gonzalo Botella-Casas
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  2. Mariano Marqués-Mateo
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  3. Luis Miragall-Alba
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  4. Daniela María Río-Vega
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  5. Eva González-Soler
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  6. Miguel Puche-Torres
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Gonzalo Botella-Casas, Mariano Marqués-Mateo, Luis Miragall-Alba and Eva González-Soler. The first draft of the manuscript was written by Gonzalo Botella-Casas and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gonzalo Botella-Casas.

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Ethics approval

The ethical committee of Hospital Clinico of Valencia approved the publication of this case report.

Consent to participate

The patient reported consented to publish his case.

Consent for publication

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1 and 2.

Competing interests

The authors declare no competing interests.

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Botella-Casas, G., Marqués-Mateo, M., Miragall-Alba, L. et al. Management of pseudoaneurysms of the internal maxillary artery derived from orthognathic surgery based on one case. Oral Maxillofac Surg 28, 963–966 (2024). https://doi.org/10.1007/s10006-023-01197-9

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  • DOI: https://doi.org/10.1007/s10006-023-01197-9

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