title: Life-threatening hemorrhage after zygomatic bone surgery. About 2 posttraumatic cases.
abstract: BACKGROUND
  Management of zygomatic bone fractures is still debated. Method and delay for intervention has to be chosen considering respective issues of operative or conservative treatments, especially hemorrhagic complications. The maxillofacial surgeon must be able to determine life-threatening situations and to react appropriately.
  
  
  METHODS
  We report 2 cases of external carotid branches pseudoaneurysm leading to massive hemorrhage after early or delayed zygomatic fracture surgery. The first patient underwent open reduction of fracture by intraoral approach. An active bleeding occurred in the immediate postoperative time. In the second case, a zygomatic osteotomy was performed 1 year after fracture. Bleeding occurred 2 weeks after surgery. In both cases, angiography demonstrated a pseudoaneurysm developed from the external carotid branches. Embolisation led to rapid bleeding control.
  
  
  CONCLUSIONS
  Severe hemorrhage resulting from maxillofacial trauma may be life-threatening. Once the "damage control" principles applied, selective embolisation of external carotid branches is an efficient alternative to surgery for the control of bleeding resulting from ruptured pseudoaneurysm.
authors.affiliation: Aix Marseille université, IFSTTAR, LBA UMR_T 24, 13916 Marseille, France; Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France. Electronic address: jmfoletti@gmail.com.
authors.forename: J-M
authors.initials: JM
authors.lastname: Foletti
authors.affiliation: Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Bruneau
authors.affiliation: Aix-Marseille université, 13284 Marseille, France; Service d'imagerie, hôpital Nord, AP-HM, 13915 Marseille cedex 20, France.
authors.forename: B
authors.initials: B
authors.lastname: Puech
authors.affiliation: Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Guyot
authors.affiliation: Aix Marseille université, IFSTTAR, LBA UMR_T 24, 13916 Marseille, France; Service de chirurgie maxillo-faciale, hôpital de la Conception, hôpital Nord, AP-HM, pavillon étoile, chemin des Bourrely, 13005 Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Chossegros
mesh_terms: D000328:Adult; D000368:Aged; D020212:Carotid Artery Injuries / Q000150:complications / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008438:Maxillary Artery / Q000473:pathology / Q000601:surgery; D010027:Osteotomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000473:pathology*; D015050:Zygoma / Q000601:surgery*; D015051:Zygomatic Fractures / Q000601:surgery*
keywords: Carotid pseudoaneurysm; Embolisation thérapeutique; Fracture zygomatique; Intensive care; Interdisciplinary health team; Prise en charge interdisciplinaire; Pseudoanévrisme de la carotide; Soins intensifs; Therapeutic embolization; Zygomatic fracture