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Beitragstitel Maxillary bleeding after Le-Fort I fracture in an elderly patient a casereport
Beitragscode P34
Autor:innen
  1. Pascal Rüegg HNO Inselspital Bern Präsentierende:r
  2. Sinisa Milenovic KSGR Chur
  3. Yves Brand Kantonsspital Graubünden
Präsentationsform Poster
Themengebiete
  • Innovation und Zukunftsentwicklung in der ORL
Abstract-Text Introduction
Bleeding of the internal maxillary arterie is a rare but potentially severe complication after Le-Fort osteothomie or Le-Fort fractures of the midface. Patients most often present with recurrent epistaxis originating from the maxillary sinus, oral hemorrhage is rarely reported. As reported by the literature the most common treatment modality is endovascular clousure of the maxillary artery by the insertion of a coil.

Case presentation
A 73-year-old patient presented with massiv oral hemorrhage. Four weeks prior the the patient underwent osteosynthesis of a bilateral Le-Fort I fracture after a fall with multiple injuries. Already during this surgery hemorrhage from the sinus was only controllable by insertion of Tabotamp in the maxillary sinus.
Due to massiv bleeding from the former vestibular incision the wound was opened and massiv bleeding from the maxillary sinus identified. As there was already a rather easy access through the wound, we decided to take an endoscopic approach. This resulted in visualizing the maxillary artery as origin of the bleeding, which was closed by a vascular clip. After this the sinus was dry and no further bleeding occurred during the hospital stay nor follow-up.

Discussion/Conclusion
This case shows that additionally to the already proven endovascular treatment, an endoscopic transsinusal approach is feasible as well, especially if there is easy access through a former approach. We recommend decision making according to the specific situation of the patient as well as availability of an interventional radiologist or endoscopically skilled ENT-surgeon.