Successful hemostasis by transcatheter arterial embolization for massive nasal hemorrhage due to facial fractures: A case report

A case of massive nasal hemorrhage due to facial bone fractures accompanied by a skull-base fracture is reported. A 72-year old woman was involved in a traffic accident and was hospitalized at the Critical Care Medical Center on July 30, 1997. The clinical diagnosis included a skull-base fracture, pneumocephalus, traumatic subarachnoid hemorrhage, unconsciousness, a traumatic cavernous stoma of the internal carotid artery, a maxillary fracture (Le Fort II), bilateral zygomatic bone fractures, an ethomonasal fracture, a right rib fracture, a crushed right lung, right hemothorax, and a pelvic fracture. Transcatheter arterial embolization (TAE) of both external carotid arteries was performed to treat hemorrhagic shock due to nasal hemorrhage on admission. Hemostasis and recovery from the hemorrhagic shock were successfully achieved.Maxillofacial trauma sometimes causes massive nasal hemorrhage. Tamponade is usually performed. However, tamponade is contraindicated for nasal hemorrhage in patients with complications such as skullbase fractures or cerebral fluid rhinorrhea. In such patients, TAE of the external carotid artery is the treatment of choice for hemostasis.