Posttraumatic carotid-cavernous sinus fistula.
OBJECTIVE
Posttraumatic carotid-cavernous sinus fistula is a rare complication of maxillofacial trauma and is seldom discussed in the literature. Motor vehicle accidents, falls, and other crush injuries contribute to the incidence of basilar skull fractures and the formation of fistulae. When injuries occur in the vessel wall, the carotid artery has the potential to fill the low-pressure cavernous sinus. The symptoms include chemosis, proptosis, pulsating exophthalmos, diplopia, ophthalmoplegia, orbital pain, audible bruits, and blindness.


METHODS
The conventional treatments include carotid ligation and embolization. These techniques have often proved to be ineffective. A new method--the occlusive balloon technique--has been developed and is described in this article. A clinical case is used to illustrate the procedure.


CONCLUSIONS
Utilization of balloon catheters provides a minimally invasive technique to treat patients, without significant morbidity or mortality. The procedure is found to be successful and predictable.
Stanton
D C
DC
Department of Oral & Maxillofacial Surgery Hospital, University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104, USA.
Kempers
K G
KG
Hendler
B H
BH
Cutilli
B J
BJ
Hurst
R W
RW
D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D020216:Carotid-Cavernous Sinus Fistula / Q000145:classification / Q000209:etiology* / Q000628:therapy; D002533:Cerebral Angiography; D003229:Conjunctival Diseases / Q000209:etiology; D004172:Diplopia / Q000209:etiology; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005094:Exophthalmos / Q000209:etiology; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000150:complications*; D019060:Minimally Invasive Surgical Procedures; D009886:Ophthalmoplegia / Q000209:etiology; D020205:Skull Fracture, Basilar / Q000150:complications; D016896:Treatment Outcome