INTRACTABLE ORONASAL HEMORRHAGE ASSOCIATED WITH CRANIOFACIAL TRAUMA : INDICATION FOR TRANSCATHETER ARTERIAL EMBOLIZATION AND LIGATION OF THE EXTERNAL CAROTID ARTERY CONSIDERED FROM THE PERSPECTIVE OF ABNORMALITY OF COAGULATION AND FIBRINOLYSIS SYSTEM

Abstract

　　Transcatheter arterial embolization (TAE) of relevant branches of the external carotid artery has been performed to manage intractable oronasal hemorrhage following craniofacial trauma. Of 129 patients with basilar skull fracture, facial fracture, or penetrating injury of head and neck, we evaluated the records of seven with intractable oronasal hemorrhage for whom TAE was considered to be indicated. All three non-survivors had severe traumatic brain injury, although only one of four survivors had severe traumatic brain injury. Non-survivors had a higher plasma d-dimer level than survivors. All three non-survivors died of hemorrhagic shock due to oronasal hemorrhage ; one during and two prior to TAE. TAE should be performed immediately for intractable oronasal hemorrhage following craniofacial trauma. In the presence of severe abnormality of coagulation and fibrinolysis systems due to traumatic brain injury, external carotid artery ligation should be considered as an alternative treatment for intractable traumatic oronasal hemorrhage.