Pseudoaneurysm of the Ascending Pharyngeal Artery as a Complication of Orthognathic Surgery: A Case Report and Literature Review

Buset T1,4*, Denoiseux B1,4, Niekel M2, Jonkergouw J1, Van de Perre J1,3,4, Van de Casteele E3,4,5 and Van Hemelen G1,3,4,5

1ZMACK Association Cranio-Maxillofacial Surgery, AZ Monica Hospital Antwerp, Belgium
2Department of Interventional Radiology, Antwerp University Hospital, Belgium
3Department of Cranio-Maxillofacial Surgery, Antwerp University Hospital, Belgium
4Department of Medicine and Health Sciences, University of Antwerp, Belgium
5All for Research VZW, Belgium

^*Correspondance to: Thibaut Buset 

 PDF  Full Text DOI: 10.25107/2474-1647.3413

Abstract

Introduction: Pseudoaneurysms are caused by injury of the vessel wall leading to subadventitial dissection and subsequent dilatation of the vessel with a persistent communication between the true arterial lumen and the dissecting cavity. Pseudoaneurysm directly related to a surgical procedure such as the Le Fort I osteotomy is an exceedingly rare complication. Furthermore, a pseudoaneurysm related to the ascending pharyngeal artery has never been reported. Case Report: A LeFort I osteotomy associated with a bilateral sagittal split osteotomy was carried out on a 15-year-old female patient for a surgical correction of Class II skeletal discrepancy associated with a deep bite. Five weeks after surgery, the patient was still experiencing significant pain in her right mandibule. The CT scan with contrast highlighted a liquid mass of 5.2 cm × 2.7 cm × 4.7 cm. An exploration of the operative site demonstrated a severe intra-oral bleeding controlled with conservative treatment. Due to recurrence of the pain and swelling, angiography was performed, revealing a pseudoaneurysm of the right ascending pharyngeal artery. This pseudoaneurysm might be related to a supraperiosteal positioning of the osteotome during the pterygomaxillary disjunction in the Le Fort osteotomy. An embolization was performed with coils placed into the distal ascending pharyngeal artery using a 3×14 Nester microcoil and the patient recovered well. In this case report a literature review was performed and a description was made of this first-time seen case of a pseudoaneurysm of the ascending pharyngeal artery after a Le Fort I osteotomy of the maxilla.

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Buset T, Denoiseux B, Niekel M, Jonkergouw J, Van de Perre J, Van de Casteele E, et al. Pseudoaneurysm of the Ascending Pharyngeal Artery as a Complication of Orthognathic Surgery: A Case Report and Literature Review. Clin Surg. 2022; 7: 3413..