Traumatic carotid cavernous fistula associated with a mandibular fracture.
Carotid cavernous sinus fistula is an abnormal vascular interconnection between a branch of the carotid artery and the cavernous sinus. This is an uncommon complication of craniofacial injuries, as it occurs in only 0.17-0.27% of cases, according to the literature. The differential diagnosis should include superior orbital fissure syndrome, orbital apex syndrome, orbital haematoma and cavernous sinus thrombosis. The case is reported of an 18-year-old white woman who was involved in a motor vehicle accident. Clinical examination revealed only mandibular fractures, with the absence of skull-base, mid-face or any other fractures. Two days after the trauma, her condition deteriorated, and extraocular movements were totally absent. Magnetic resonance angiographic scanning was performed, and a carotid cavernous sinus fistula was found. This was treated by embolization resulting in restoration of eye movement and vision.
Paza
A O
AO
Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Campinas, São Paulo, Brazil.
Farah
G J
GJ
Passeri
L A
LA
D000063:Accidents, Traffic; D000293:Adolescent; D021721:Balloon Occlusion / Q000379:methods*; D001763:Blepharoptosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging* / Q000628:therapy; D003937:Diagnosis, Differential; D005094:Exophthalmos / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D005131:Eye Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008337:Mandibular Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography