title: Life-threatening oronasal hemorrhage managed by transcatheter embolization of bilateral maxillary arteries in an elderly patient with comminuted LeFort I fracture.
abstract: Massive orofacial hemorrhage mostly occurs in younger individuals unilaterally and is associated with extensive LeFort fractures. Here we describe a 91-year-old man who sustained a life-threatening hemorrhage of the bilateral internal maxillary artery (IMA) system with a comminuted LeFort I fracture caused by a road traffic accident while he was driving. His injury severity score was high (34), but no severe brain injury was sustained. Transarterial embolization (TAE) was performed to control the intractable hemorrhage. The patient survived and has an acceptable outcome. Although rare, this case may be representative of a trend in maxillofacial injuries in the elderly resulting from worldwide motorization and steady aging of more active populations. Life-threatening hemorrhage of the bilateral IMA system occurs even in LeFort I fractures. Controlling an intractable oronasal hemorrhage with TAE would lead to survival with less severe morbidity, even for the very elderly with no severe brain injuries.
authors.affiliation: Head, Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan. Electronic address: hsc12@hotmail.com.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Imai
authors.affiliation: Former Head, Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Michizawa
authors.affiliation: Staff, Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Orthopedic Team, Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Osaka, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Oba
authors.affiliation: Head, Intensive Care Team, Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Osaka, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sawano
mesh_terms: D000063:Accidents, Traffic; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D005593:Fracture Fixation, Internal / Q000379:methods; D018460:Fractures, Comminuted / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008438:Maxillary Artery; D012887:Skull Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery