We report the case of a 24-year-old male referred to the Maxillofacial Surgery Department of our institution for evaluation of cleft lip and palate.
The patient had no history of interest except for type surgery not specified for his underlying disease years before, and secondary malar hypoplasia.
On physical examination the patient had nasal pyramid dysmorphia.
Cephalometric analysis and imaging studies including multidetector computed tomography (MDCT) confirmed the presence of maxillary hypoplasia.
A 2-phase surgical management was planned based on clinical findings.
In the first phase, a LeFort type 1 osteotomy was performed with placement of internal maxillary distractors.
Once the maxillomandibular relationship was corrected, a second phase would be carried out, which would probably include extraction of teeth and rehabilitation with dental implants.
The first phase of treatment was performed without immediate surgical complications.
The patient came 27 days later to the emergency department with epistaxis for which bilateral anterior taping and admission were indicated.
It was decided to perform MDCT after intravenous contrast (IVC) administration for vascular study of the facial mass, in which a pseudoaneurysm of approximately 8 × 9 × 8 mm was evidenced in the right maxillary anterior posterior fossa, probably anteroposterior diameter.
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During admission, the patient presented significant episodes of oral and nasal bleeding with important hemodynamic consequences, so a posterior taping with Foley catheters was performed.
One day later, selective arteriography of the right external carotid artery was performed with therapeutic intent, which confirmed the presence of pseudoaneurysm and its dependence on the internal maxillary artery.
Embolization was performed in the same intervention with 50% cyanoacrylate gum.
The patient tolerated the procedure correctly and was transferred to the maxillofacial surgery unit.
The patient was discharged 6 days after embolization due to no new bleeding episodes or hemodynamic changes.
