Pseudoaneurysm of the Facial Artery. Diagnosis and Management

Extracranial carotid artery pseudoaneurysms are relatively rare since trauma to the external carotid artery branches usually results in total transection rather than partial laceration of the blood vessel. Historically, surgical isolation and ligation of the supplying vessels was the recommended treatment. Reconstruction of the vessel is usually not necessary in the head and neck due to the multiple collaterals and anastomoses of the region. Advances in interventional radiology now provide non-surgical treatment options, including embolization performed in conjunction with angiography. Benefits of embolization include minimal invasiveness, selectivity, and avoidance of general anesthesia. The authors report the case of a 80-year-old male patient with a right facial pulsatile mass of 2 months evolution that appeared after suffering facial trauma. CT angiography and digital subtraction angiography demonstrated a pseudoaneurysm of the right facial artery. Emergent endovascular embolization with thrombin and surgical exposure and ligation was performed with fast satisfactory resolution and no complications after 15 months follow-up. Although formation of pseudoaneurysm in the region of the face and neck is rare, we consider that its inclusion in the differential diagnosis of a neck mass is extremely important, especially after facial trauma. Major complications can be the result of an incorrect diagnosis and treatment. Embolization is a less invasive method than traditional surgical techniques; in cases of bleeding, it aims at the occlusion of the vessel and in most cases represents the final treatment. Surgical exploration, ligation and removal have no consequences to tissue perfusion due to the high number of anastomoses in the facial region, and the risk of perioperative complications is minimal.

1.Dediol E, Manojlovic S, Biocic J, Franceski D: Facial artery pseudoaneurysm without evidence of trauma. Int. J. Oral Maxillofac. Surg 40: 988–990, 2011

2. Germiller JA, Myers LL, Harris MO, Bradford CR: Pseudoaneurysm of the proximal facial artery presenting as oropharyngeal hemorrhage. Head Neck 23:259–63, 2011