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  • Internal Maxillary Artery Pseudo-aneurysm: A Rare Complication of Temporo-Mandibular Joint Surgery – Case Report

    Final Number:
    209

    Authors:
    Chen Xu M.D.; Vance Tutor D.D.S.; Richard Wiley Williamson MD; David Dattilo D.D.S.; Khaled M. Aziz MD, PhD

    Study Design:
    Other

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: Over the past two decades, temporomandibular joint (TMJ) replacement with prosthetic devices has become an acceptable treatment for multiple conditions including: idiopathic condylar resorption, degenerative joint disease, ankyloses, among others. With the increase of the procedure, the incidents of other complications such as facial nerve damage, infections, and heterotopic bone formation around the prosthesis have increased. Another rare complication is the formation of an internal maxillary artery aneurysm (IMAA). There have been multiple cases of IMAA noted with facial traumas involving multiple fractures; however, with all of the joints being placed, the incidents of IMAA in the setting of TMJ surgery has not been studied or reported.

    Methods: Case presentation of an internal maxillary artery aneurysm forming after a right TMJ arthroplasty and reconstruction with a Biomet stock prosthesis.

    Results: The patient, after undergoing a right TMJ arthroplasty and reconstruction, was found to have a right IMAA and was treated with endovascular coiling. Complete aneurysm embolization was achieved without compromise to the distal vasculature with significant improvement of patient symptoms.

    Conclusions: Internal maxillary artery aneurysms are rare complications seen mostly in post-traumatic patients and rarely seen in maxillofacial surgeries. The above case presents a patient who developed such a lesion after TMJ surgery with prosthesis placement, presenting a noteworthy complication of a procedure that has increasingly been performed over the past 20 years. Bringing into light the possibility of such a lesion will allow clinicians to be better equipped to recognize and appropriately treat this disease, continuing to support the paramount role an inter-disciplinary team plays in improving patient care.

    Patient Care: By shedding light onto a very rare, and previously unreported complication of TMJ surgery, this presentation will allow clinicians to be better equipped in recognizing the disease and also promote the inter-disciplinary approach to patient care, showing the importance of careful discussion, communication, and coordination between different specialties.

    Learning Objectives: By conclusion of this session, participants should be able to recognize the possibility of this rare complication of TMJ surgery and to better treat and manage such patients in an inter-disciplinary approach.

    References: 1. Bozkurt M, Kapi E, Karakol P, and Yorgancilar E, “Sudden rupture of the internal maxillary artery causing pseudoaneurysm (mandibular part) secondary to subcondylar mandible fracture,” Journal of Craniofacial Surgery, 20(5), 1430–1432, 2009. 2. Chakrabarty S, Majumdar SK, Ghatak A, and Bansal A, “Management of pseudoaneurysm of internal maxillary artery resulting from trauma,” Journal of Maxillofacial and Oral Surgery, 14(1), 203–208, 2015. 3. Fan X and Mao Q, “Life-threatening oral hemorrhage of a pseudoaneurysm after raising of a fractured zygoma,” British Journal of Oral and Maxillofacial Surgery, 40(6), 508–509, 2002. 4. Katakol B and Govindaraj E, “Pseudoaneurysm of the internal maxillary artery following mandibular condylar fracture,” Ann Maxillofac Surg, 4(2), 201-204, 2014. 5. Barbalho JC, Santos ES, Menezes JMS, Goncalves FR, Chagas OL, “Treatment of pseudoaneurysm of internal maxillary artery: A case report,” Craniomaxillofac Trauma Reconstr, 3(2), 87-89, 2010. 6. Masoomi A, Fazlipour A, and Davoodi M, “Traumatic pseudoaneurysm of internal maxillary artery: A case report,” Iran J Radiol, 6(1), 37-39, 2009. 7. Chepla KJ, Totonchi A, Hsu DP, and Gosain AK, “Maxillary artery pseudoaneurysm after le fort I osteotomy: treatment using transcatheter arterial embolization,” Journal of Craniofacial Surgery, 21(4), 1079–1081, 2010. 8. Silva AC, O'Ryan F, Beckley ML, Young HY, and Poor D, “Pseudoaneurysm of a branch of the maxillary artery following mandibular sagittal split ramus osteotomy: case report and review of the literature,” Journal of Oral and Maxillofacial Surgery, 65(9), 1807–1816, 2007 9. Eller JL, Sasaki-Adams D, Sweeney JM, Abdulrauf SI, “Localization of the internal maxillary artery for extracranial-to-intracranial bypass through the middle cranial fossa: A cadaveric study,” J Neurol Surg B Skull Base, 73(1), 48-53, 2012. 10. Siniscalchi EN, Catalfamo L, Pitrone A, Papa R, Fama F, Lo Giudice G, Cervino G, Cicciu M, De Ponte FS, “Traumatic pseudoaneurysm of the internal maxillary artery: A rare life-threatening hemorrhage as a complication of maxillofacial fractures,” Case Reports in Medicine, 2016.

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