title: Penetrating foreign body in the masticator space with injury to the internal maxillary artery: a surgical challenge.
abstract: INTRODUCTION Foreign bodies (FBs) in the masticator space (MS) are a unique problem because of the difficulty of accessing this deep compartment within the head and neck. In addition, MS contents include critical structures such as the internal maxillary artery (IMA) and mandibular nerve. CASE HISTORY A 39-year-old tradesman was involved in a construction accident whereby a metallic projectile from a machinery drill penetrated his left cheek. Computed tomography revealed a metallic object of dimension 1.9 ×1.2 cm within the MS, with concomitant fracture of left maxillary anterior and lateral walls. Surgery was indicated in view of constant pain and swelling. The FB was removed through the cheek laceration with the aid of an X-ray image intensifier. Persistent significant bleeding was observed within the wound cavity after FB removal that could not be arrested despite attempts at haemostasis with adrenaline packing and oxidised cellulose polymers. Urgent selective left external carotid angiography showed breach of a distal branch of the left internal maxillary artery with contrast extravasation. Embolisation of this branch was undertaken successfully with a liquid agent. CONCLUSIONS This is the first time a FB within the MS with injury to the internal maxillary artery has been described.
authors.affiliation: Department of General Surgery, Section of Plastic, Reconstructive and Aesthetic Surgery, Tan Tock Seng Hospital , Singapore.
authors.forename: Shaun S
authors.initials: SS
authors.lastname: Tan
authors.affiliation: Department of General Surgery, Section of Plastic, Reconstructive and Aesthetic Surgery, Tan Tock Seng Hospital , Singapore.
authors.forename: M S
authors.initials: MS
authors.lastname: Yeo
authors.affiliation: Department of General Surgery, Section of Plastic, Reconstructive and Aesthetic Surgery, Tan Tock Seng Hospital , Singapore.
authors.forename: Ghp
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of General Surgery, Section of Plastic, Reconstructive and Aesthetic Surgery, Tan Tock Seng Hospital , Singapore.
authors.forename: Msy
authors.initials: M
authors.lastname: Ho
authors.affiliation: Department of General Surgery, Section of Plastic, Reconstructive and Aesthetic Surgery, Tan Tock Seng Hospital , Singapore.
authors.forename: M L
authors.initials: ML
authors.lastname: Ang
authors.affiliation: Department of Neuroradiology, National Neuroscience Institute , Singapore.
authors.forename: W
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of General Surgery, Section of Plastic, Reconstructive and Aesthetic Surgery, Tan Tock Seng Hospital , Singapore.
authors.forename: E C
authors.initials: EC
authors.lastname: Cheong
mesh_terms: D000328:Adult; D000792:Angiography; D005151:Facial Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008438:Maxillary Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D060051:Occupational Injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Embolisation; Foreign bodies; Internal maxillary artery; Masticator space