2021, Number 4
Pseudoaneurism of the superficial temporal artery in temporomandibular joint ankylosis release surgery: case report
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ABSTRACT
The superficial temporal artery aneurysm (STAA) is a rare disorder of unknown etiology, although it is related to different factors including trauma, surgical lacerations, spontaneous formation or iatrogenesis of capillary, neurosurgical procedures, removal of cysts, and extension of arthroplasty of the temporomandibular joint among others. The purpose of this study is to present a clinical case of a post traumatic pseudoaneurysm of the superficial temporal artery in the temporomandibular ankylosis release surgery.INTRODUCTION
Superficial temporal artery aneurysm is a rare disorder, which was first described in 1743 by Bartholin; in 1955 it was studied histologically by Martin and Shoemater. Since then few superficial temporal artery aneurysms have been reported.1
The pathophysiological mechanism of this disorder has not yet been well defined but its etiology is related to various factors such as trauma, damage from bladed weapons or surgical lacerations, spontaneous or iatrogenic formation of capillary procedures, neurosurgical, removal of cysts, an extension of arthroplasty of the temporomandibular joint among others.1,2
Aneurysms can be classified into true or pseudoaneurysms, the difference between these pathologies is presented in the histopathological examination. Pseudoaneurysm has been related to trauma and its incidence is higher in young men, while true aneurysms are not related to a traumatic agent, on the contrary, are linked to syndromes such as Marfan and giant cell arteritis, atherosclerotic changes are an infrequent risk factor in the occurrence of true aneurysms.3
For the presumptive diagnosis of pseudoaneurysm of the superficial temporal artery (PASTA) different methods have been used among them are mentioned the clinical history and physical examination where it is important to make a correct clinical observation of a mass in the temporal region and palpation of it; symptoms in the patient may be absent or present headaches, dizziness, hemorrhages, discomfort in the auricular sector, and neurological deficit, generally these symptoms may appear in a period of two to six weeks after the trauma.3,4
Imaging studies can contribute to the diagnosis of PASTA among these the most described are angiotomography, magnetic resonance, doppler, and digital angiography. Selective angiography is a method used in the diagnosis and helps to detect the presence of arteriovenous fistulas and can eventually be used in therapy if aneurysm embolization is performed. Currently, these complementary studies are rarely used and only in apparently complicated cases.5-7 The treatment of choice for bone pathology is ankylosis release surgery whose purpose is the prevention of complications generated by the aneurysm and symptom relief.5-7
For the above mentioned, this article aims to present a clinical case of a post-traumatic pseudoaneurysm of the superficial temporal artery in temporomandibular ankylosis release surgery, to provide knowledge to the professional of this peculiar and rare pathology.
CASE REPORT
A male patient, 28 years old, presented bilateral mandibular ankylosis after motorcycle trauma, which originated mandibular fracture progressively limiting the mouth opening for 10 years.
Therefore, the patient was prepared for mandibular ankylosis release surgery, and complementary examinations were requested (tomography with axial and coronal sections and 3D reconstruction) (Figure 1).
Surgical procedure: under general anesthesia with nasotracheal intubation with fiberscope, a preauricular approach with temporal extension was performed. During the surgical procedure, the right mandibular ankylosis was released without any complication, at the end of the procedure the process of releasing the left ankylosis was started, during the osteotomy, there was abundant and continuous arterial bleeding, and conventional hemostasis maneuvers were applied, during the osteotomy, there was abundant and continuous arterial bleeding, conventional hemostasis maneuvers were applied, using thermal techniques and ligation of all the probable surrounding arteries, the bleeding did not stop, so a compressive tamponade was left in the area and the patient was transferred to intensive care for four days, in which the angioTAC study was performed, which determined the presence of an aneurysm of the superficial temporal artery (Figure 2).
DISCUSSION
Superficial temporal artery aneurysms are pathologies caused by trauma, car accidents, sports, or iatrogenic accidents that appear approximately one month after the injury occurs, there has been a low prevalence since 1944 of this disorder with only 386 cases in the world literature.8 True aneurysms are even rarer, secondary to atheromatosis. They may be associated with Ehler-Danlos syndrome. It usually presents as a painless asymptomatic pulsatile mass in the region over the zygomatic arch or in the temporal line, where it is not protected by the muscle.8,9
There is no unanimity in the literature as to the imaging technique of choice for its study. Many authors defend arteriography as being a vascular pathology, the existence of a possible risk of complication of 1%,9 and making possible a treatment in the same act by embolization.8 There are different therapeutic alternatives ranging from simply repeated compression to embolization and surgery.4-9
CONCLUSION
The aneurysm of the superficial temporal artery has been described as a pathology of low prevalence, with a poorly defined pathophysiological mechanism, some authors attribute it as a result of trauma, in its diagnosis have been used conventional methods such as tomography, although there are other complementary studies little used that provide a better diagnosis of the case, unfortunately, this study is rarely requested as a procedure before surgery, which constitutes a debate on the importance of requiring all the necessary complementary tests to obtain a better diagnosis and avoid pre- and postoperative complications to the patient. Therefore, it is proposed that all patients should have an angioTAC before the release of ankylosis caused by trauma.
REFERENCES
AFFILIATIONS
1 Odontólogo especialista en Cirugía Maxilofacial y Craneofacial, Universidad Nacional Autónoma de México. Subdecano de la Unidad Académica de Salud y Bienestar y Docente titular.
2 Odontólogo de la Universidad de Cuenca, Ecuador. Máster Universitario en Educación Universitaria, Universidad Europea de Madrid, España.
3 Odontóloga de la Universidad Católica de Cuenca, Ecuador. Magíster en Bioética, Universidad del Azuay de Cuenca. Docente en la carrera de Odontología.
Research support: the present research has not received any specific grants from agencies in the public, commercial, or nonprofit sectors. The present research project was financed by the authors for its execution and conclusion.
CORRESPONDENCE
Santiago José Reinoso-Quezada. E-mail: sreinoso@ucacue.edu.ecReceived: Agosto 2018. Accepted: Octubre 2018.