title: [Iatrogenic palatine necrosis by embolization of sphenopalatine arteries during management of a rebel epistaxis].
abstract: BACKGROUND
  The treatment of epistaxis sometime requires an embolization. This may result in ischemic palate necrosis, oronasal communication and dental losses. The repair of these lesions is complex.
  
  
  METHODS
  A 53-year-old patient, suffering from high blood pressure and hypercholesterolemia, benefited from bilateral embolization of the sphenopalatine arteries in order to treat a persistent epistaxis. He developed a middle cerebral artery stroke in the aftermath. During the treatment of the neurological sequelae, a necrosis of the 2/3 of the posterior aspect of the hard palate was discovered. The angio-MRI showed an obstruction of both sphenopalatine arteries and of their vascular supplies resulting in a bilateral involvement of the alveolar bone. The diagnosis of iatrogenic palate necrosis was made. Tissue repair was successfully achieved by two loco-regional flaps. The dental rehabilitation was made by mean of a removable prosthesis.
  
  
  CONCLUSIONS
  Palatine necrosis following embolization of the sphenopalatine arteries is uncommon. Ischemia resulted in a loss of substance in form of a punch, similar to noma's lesions. It could also be a consequence of the vascular background. The management of these lesions is complex and calls for forensic reflection about the iatrogenic origin.
authors.affiliation: Service de chirurgie maxillo-faciale, chirurgie plastique et stomatologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; Service de stomatologie et de chirurgie maxillo-faciale, hôpital de la Timone, boulevard Jean-Moulin, 13385 Marseille cedex 5, France.
authors.forename: S
authors.initials: S
authors.lastname: Adam
authors.affiliation: Service d'anesthésie réanimation, CHU Sylvanus Olympio Lomé, 08 BP8146, Lomé, Togo. Electronic address: hamzasama@hotmail.com.
authors.forename: H D
authors.initials: HD
authors.lastname: Sama
authors.affiliation: Service de stomatologie et de chirurgie maxillo-faciale, hôpital de la Timone, boulevard Jean-Moulin, 13385 Marseille cedex 5, France.
authors.forename: C
authors.initials: C
authors.lastname: Chossegros
authors.affiliation: Service de chirurgie maxillo-faciale, chirurgie plastique et stomatologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Bedrune
authors.affiliation: Service de chirurgie maxillo-faciale, chirurgie plastique et stomatologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France.
authors.forename: I
authors.initials: I
authors.lastname: Chesnier
authors.affiliation: Service de chirurgie maxillo-faciale, chirurgie plastique et stomatologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Pradier
mesh_terms: D001158:Arteries / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004844:Epistaxis / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000473:pathology; D009666:Nose / Q000098:blood supply / Q000601:surgery; D021362:Palate, Hard / Q000098:blood supply / Q000473:pathology*; D056739:Pterygopalatine Fossa / Q000098:blood supply* / Q000601:surgery; D012008:Recurrence
keywords: Artère sphéno-palatine; Embolisation; Embolization; Epistaxis; Necrosis; Nécrose; Sphenopalatine artery; Épistaxis