Transcatheter arterial embolization in the treatment of maxillofacial trauma induced life-threatening hemorrhages.
BACKGROUND
Life-threatening hemorrhages with hemodynamic instability are uncommon in patients with sustained maxillofacial trauma, but when they occur, require immediate surgical intervention if conservative treatment fails. This study assessed the effects of transcatheter arterial embolization (TAE) in the treatment of maxillofacial trauma-induced life-threatening hemorrhages.


METHODS
From January 2004 to January 2007, eight ambulatory patients admitted for maxillofacial injuries with life-threatening hemorrhaging and hemodynamic instability (systolic blood pressure < or = 90 mm Hg) caused primarily by intractable oronasal bleeding who subsequently underwent TAE were included in this study.


RESULTS
Maxillofacial trauma was caused by motorcycle traffic injuries (6 cases), motor vehicle injury (1 case), and fall injury (1 case). All patients exhibited documented Le Fort III fractures. The average Glasgow Coma Scale score was 4.7. TAE was successfully performed and hemorrhaging arrested in all patients. Three deaths occurred (38%) from severe traumatic brain injury. The other five patients (62%) survived without development of systemic or neurologic complications post-TAE.


CONCLUSIONS
Conservative treatment consisting of packing of the nares, compression, and blood transfusion should always precede TAE as the primary protocol. When conservative treatment fails, as shown either by the need for continued blood product replacement exceeding 1,500 mL and a systolic blood pressure < or = 90 mm Hg, TAE intervention should immediately be considered as an alternative recourse before other surgical interventions.
Department of Radiology, China Medical University Hospital, Taichung, Taiwan, ROC. cyfmagic@yahoo.com.tw
Yung-Fang
YF
Chen
Iuan-Hong
IH
Tzeng
Ying-Hsuan
YH
Li
Yu-Chien
YC
Lo
Wei-Ching
WC
Lin
Hsein-Jar
HJ
Chiang
Ruey-Fen
RF
Chen
Wu-Chung
WC
Shen
D000058:Accidental Falls; D000063:Accidents, Traffic; D000328:Adult; D000792:Angiography; D002343:Carotid Artery, Internal; D002404:Catheterization / Q000379:methods; D015331:Cohort Studies; D016638:Critical Illness; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008446:Maxillofacial Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult