Treatment of Pseudoaneurysm of Internal Maxillary Artery Resulting from Needle Injury

Pseudoaneurysm of internal maxillary artery (IMA) after trauma is rare, and most cases reported are caused by maxilla-facial blunt trauma. Pseudoaneurysm is discontinuity in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space producing pulsatile hematoma rapidly. A 44-years-old woman presented with a pulsatile swelling and pain in the left parotid region. She underwent the masticatory muscle reduction using needle injection in dentistry 1 month ago. The left facial pulsatile swelling developed after the procedure immediately and uncontrolled bleeding occurred on the day of visit to our institution. We performed emergency angiography and diagnosed pseudoaneurysm of left IMA. We treated by embolization with Histoacryl Glue through left IMA. IMA total occlusion was confirmed and symptoms improved. Pseudoaneurysm following blunt trauma of the face have been reported but are few. Furthermore, there is no report of IMA pseudoaneurysm due to direct injury by needle. Recently, many cosmetic surgery procedures using injection techniques have been performed, and it is necessary to pay attention to the direct vessel injury by the needle. And endovascular therapies can give early recovery with minimal morbidity and avoids injury to the facial nerve and its branches.