Case report
External carotid artery blood supply to the orbit

https://doi.org/10.1016/j.ijporl.2007.06.013Get rights and content

Summary

The utility of angiography and embolisation of selected branches of the external carotid artery is occasionally helpful in the management of recurrent epistaxis, pre-operative devascularisation of tumours such as angiofibromas, and other head and neck conditions. The use of embolisation for recalcitrant post-tonsillectomy bleeding due to the formation of an aneurysm or pseudoaneurysm of branches of the external carotid artery has been described [P. Simoni, J. Bello, B. Kent, Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization, Int. J. Pediatr. Otorhinolaryngol. 59 (2) (2001) 125–128]. There are also reports of pseudoaneurysm formation on the internal carotid following tonsillectomy [F. Tovi, A. Leiberman, Y. Hertzanu, L. Golcman, Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy, Int. J. Pediatr. Otolaryngol. 13 (1987) 69–75]. The repeated presentation of a 5-year-old girl with post-operative tonsillectomy bleeding on three separate occasions, each approximately 1 week apart, prompted the consideration of the diagnosis of aneurysm formation, and hence, angiography was performed. The anomalous finding from this study precluded embolisation due to the risk of blindness. This experience has prompted this review which highlights the important issues of angiographic assessment prior to embolisation. The relevance of this to external carotid artery ligation is also reflected upon.

Section snippets

Case report

TR is a 5-year-old girl who underwent an elective adenotonsillectomy by a private specialist. The operative notes indicate that it was a routine procedure, with the adenoidectomy performed using suction monopolar diathermy, and the tonsillectomy by using blunt dissection and bipolar diathermy for haemostasis. In keeping with the practice of the surgeon, the anterior and posterior tonsillar pillars were sutured together. Five days later, she presented to the emergency department of the tertiary

Discussion

This unusual finding prompted a review of the literature for descriptions of similar cases. None were evident where this finding is reported. There are, however, several reports of anomalous origins of the ophthalmic artery from the internal maxillary artery and numerous reports of embolisation used for post-tonsillectomy haemorrhage.

The arterial supply to the palatine tonsils includes the descending palatine artery (from the internal maxillary artery), the ascending pharyngeal artery, the

References (11)

  • P. Simoni et al.

    Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization

    Int. J. Pediatr. Otorhinolaryngol.

    (2001)
  • F. Tovi et al.

    Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy

    Int. J. Pediatr. Otolaryngol.

    (1987)
  • M. Hoff et al.

    Arterial aneurysms as cause of gushing post-tonsillectomy hemorrhage

    Laryngorhinootologie

    (2005)
  • M.J. Opatowsky et al.

    Endovascular treatment of hemorrhage after tonsillectomy in children

    Am. J. Neuroradiol.

    (2001)
  • P. Walshe et al.

    An unusual complication of tonsillectomy

    Surgeon

    (2005)
There are more references available in the full text version of this article.

Cited by (0)

View full text