Internal maxillary artery pseudoaneurysm: a near fatal complication of seemingly innocuous pharyngeal trauma.
A 2-year-old boy presented with persistent pain and oral blood loss after falling with a toothbrush in his mouth. Initial routine inspection of the oropharynx showed no abnormalities. Recurrent blood loss instigated a reinspection under general anesthesia revealing the head of the toothbrush embedded in the nasopharynx. The toothbrush was removed without problems but several hours later a near fatal rebleeding occurred, requiring aggressive fluid resuscitation. Subsequently, the patient was transferred to our pediatric intensive care unit for further evaluation and treatment. CT angiography (CTA) showed a pseudoaneurysm of the internal maxillary artery which was successfully coiled, and further recovery was uneventful. Pediatric pharyngeal trauma is a common entity with rare, but potentially life-threatening, complications. In case of pharynx lesions, bleeding, and persistent pain, flexible endoscopy by an otolaryngologist is mandatory. In case of persistent bleeding vascular imaging is essential with CTA being a reliable alternative for the more invasive angiography.
Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
M P
MP
Hennus
Department of Pediatric Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
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Speleman