Traumatic carotid-cavernous sinus fistula （tCCF） is an arteriovenous shunt caused by internal carotid artery rupture in the cavernosus sinus, resulting from head injury. This leads to a triad of symptoms including pulsating exophthalmos, chemosis with conjunctival hyperemia, and orbital bruit. Because of life-threatening problems and local swelling after injury, it is difficult to diagnose tCCF at an early stage. Delayed treatment can cause irreversible neurological and/or ophthalmological damage. Moreover, it may lead to profuse nasal bleeding and even death. Here, we report a rare case of tCCF with a facial fracture after a sports accident.
A 35-year-old man suffered a facial injury by bumping against another player during a baseball game. He had multiple fractures of the mandible and maxilla, but no other fractures, including cranial base fracture, were apparent. Open reduction and fixation of the mandible and conservative reduction of the maxilla were performed under general anesthesia. Exophthalmos and ophthalmoplegia were noted on the 16th day after injury. Diagnostic imaging was performed, and a neurosurgeon diagnosed tCCF. Successful management was achieved with no sequelae by endovascular surgery.
Careful observation and prompt cooperation with specialists are very important for the treatment of maxillofacial trauma.