2003 Volume 55 Issue 2-4 Pages 151-154
To reduce facial bone fracture correctly, fractured fragments must be released freely once and set to an original skeletal structure. At the same time, the dissection and the reduction technique should not make the closed vessels and nerves injured. Here a 47-year-old female case of massive arterial hemorrhage at reducing malar bone fracture is presented. In the pterigopalatine fossa, which is a narrow space, many important vessels and nerves, especially maxillary artery, passed. It is very difficult to control the hemorrhage from the injured maxillary artery, where is deep from facial surface and can be hardly managed from oral cavity. Preoperatively this case had had intermittent epistaxis and the opening mouth had been limited in 17 m m. Because the skeletal deformity of the fractured malar bone was mainly in the zygomatic arch, and the patient refuse d her facial skin incision, Gillies's temporal approach, which set the incision only at the temporal hairy area, was indicated. At reducing the malar bone correctly by this technique, massive arterial hemorrhage occurred in the nasal an d oral cavity. Although a gauze pressure hemostasis and Belloque tamponade were applied, the blood loss was up to 1,400 ml in the volume and could not be controlled at the time. Emergent angiography was per formed and the leakage of post-superior alveolar artery, which is a branch of maxillary artery, was detected as an injured sign. Then transcatheter embolization with coils was performed under radiographic monitoring and resulted in perfect hemostasis. The postoperative general condition was good and the normal function and the degree of opening mouth and the malar form were acquired. The experience that unexpected massive arterial hemorrhage at reducing a malar bone fracture was controlled with embolization procedure is reported.
