title: Delayed Carotid Dissection Following Lower Lip Revascularization in the Setting of Hyoid Fracture--A Case Report and Review of the Literature.
abstract: Traumatic injuries to the lip are common, but injuries that require revascularization of the lower lip are infrequent and pose a major challenge to the reconstructive surgeon. This report describes the case of a 53-year-old woman who sustained a lower lip avulsion injury, a comminuted mandibular parasymphyseal fracture, and a hyoid bone fracture secondary to a bicycle accident. Trauma workup included computed tomographic angiography of the head and neck, which did not show vascular injury. Despite successful revascularization of the lower lip, on postoperative day 11 the patient developed a large internal carotid artery dissection and middle cerebral artery stroke. This case highlights the importance of careful postoperative monitoring after high-energy facial trauma, particularly in the setting of vascular and bony injuries.
authors.affiliation: Medical Student, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Shantum
authors.initials: S
authors.lastname: Misra
authors.affiliation: Resident Physician, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Corbett A
authors.initials: CA
authors.lastname: Haas
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
authors.forename: Meredith
authors.initials: M
authors.lastname: August
authors.affiliation: Assistant Professor, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: keberlin@mgh.harvard.edu.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Eberlin
mesh_terms: D000792:Angiography / Q000379:methods; D001642:Bicycling / Q000293:injuries; D020215:Carotid Artery, Internal, Dissection / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D018460:Fractures, Comminuted / Q000601:surgery; D006801:Humans; D006928:Hyoid Bone / Q000293:injuries* / Q000601:surgery; D008046:Lip / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D011183:Postoperative Complications; D020521:Stroke / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods*