A case of spontaneous closure of a traumatic carotid-cavernous sinus fistula after conservative treatment with manual carotid compression associated with fractures of the zygoma and jaw

OGATA Katsumori, YOSHIDA Ryoji, YONEDA Masakazu, TAKESHITA Hisashi, NAKAYAMA Hideki, SHINOHARA Masanori

doi:10.5794/jjoms.65.719

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Other Title

頰骨および顎骨骨折に伴って発症し用手的頸動脈圧迫法にて治癒した外傷性頸動脈海綿静脈洞瘻の1例
ホウボネオヨビガッコツコッセツニトモナッテハッショウシヨウシュテキケイドウミャクアッパクホウニテチユシタガイショウセイケイドウミャクカイメンジョウミャクドウロウノ 1レイ

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<p>Traumatic carotid-cavernous sinus fistula (t-CCF) is an arteriovenous fistula formed by the tearing of the internal carotid artery running in the cavernous sinus, accompanied by head/maxillofacial injuries. Patients with this disease rarely show spontaneous closure and often require urgent endovascular treatment. We report a case of t-CCF that developed following jaw and zygoma fractures and was successfully treated by manual carotid compression. A 35-year-old man was referred to our hospital to undergo treatment for multiple maxillofacial fractures. On the first day after injury, open reduction and internal fixation of the mandible were conducted with the patient under general anesthesia. On the fifth day after injury, diplopia of the left eye suddenly appeared. On the seventh day after injury, left exophthalmos/edema of the left upper eyelid/left abducens nerve palsy/bilateral ptosis, and hyperemia of the bulbar conjunctiva appeared. On the 15th day after injury, cerebral angiography revealed a definitive diagnosis of t-CCF. Supervised manual carotid compression during the waiting period before endovascular treatment led to improvement in various symptoms from the 19th day after injury. Cerebral angiography, which was performed again for endovascular treatment, revealed that arteriovenous fistula resolved spontaneously. Therefore, treatment was discontinued, and the patient was followed up with a conservative approach. By 9 months after injury, all symptoms, including left oculomotor nerve palsy had disappeared. There was no evidence of recurrence 10 years after injury.</p>

Journal

Japanese Journal of Oral and Maxillofacial Surgery

Japanese Journal of Oral and Maxillofacial Surgery 65 (11), 719-725, 2019-11-20

Japanese Society of Oral and Maxillofacial Surgeons

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