Pub Date : 2023-11-18DOI: 10.1177/27325016231213061
Briana J. Burris, R. Regenhardt, J. Rabinov, Joseph P. McCain
A traumatic arteriovenous fistula (AVF) is a type of acquired vascular malformation, caused by blunt or penetrating trauma. Traumatic AVFs result in a pathologic connection between arterial and venous vasculature, bypassing the corresponding capillaries. When an intra-operative insult to vasculature within a surgical site is implicated in the subsequent formation of a traumatic AVF, the suspected etiology is iatrogenic. Although the most common etiology of traumatic AVFs of the entire body is iatrogenic trauma, intraoperative vascular insults (ie, ligation and cauterization) are routinely delivered within maxillofacial surgical sites, without formation of an acquired vascular malformation. A traumatic AVF in the pre-auricular region is exceedingly rare and has infrequently been described as a complication following minimally invasive temporomandibular joint (TMJ) surgery, managed with endovascular surgery. We describe a rare case of bilateral TMJ arthroscopies complicated by the formation of a pulsatile, traumatic AVF between the right superficial temporal artery and right retromandibular vein, treated with minimally invasive endovascular embolization by the interventional radiology team. This case report highlights the diagnosis of a traumatic AVF in the pre-auricular region and multi-specialty management of an early complication of minimally invasive maxillofacial surgery.
{"title":"Management of Traumatic Arteriovenous Fistula as a Complication of Minimally Invasive Endoscopic Maxillofacial Surgery: A Case Report","authors":"Briana J. Burris, R. Regenhardt, J. Rabinov, Joseph P. McCain","doi":"10.1177/27325016231213061","DOIUrl":"https://doi.org/10.1177/27325016231213061","url":null,"abstract":"A traumatic arteriovenous fistula (AVF) is a type of acquired vascular malformation, caused by blunt or penetrating trauma. Traumatic AVFs result in a pathologic connection between arterial and venous vasculature, bypassing the corresponding capillaries. When an intra-operative insult to vasculature within a surgical site is implicated in the subsequent formation of a traumatic AVF, the suspected etiology is iatrogenic. Although the most common etiology of traumatic AVFs of the entire body is iatrogenic trauma, intraoperative vascular insults (ie, ligation and cauterization) are routinely delivered within maxillofacial surgical sites, without formation of an acquired vascular malformation. A traumatic AVF in the pre-auricular region is exceedingly rare and has infrequently been described as a complication following minimally invasive temporomandibular joint (TMJ) surgery, managed with endovascular surgery. We describe a rare case of bilateral TMJ arthroscopies complicated by the formation of a pulsatile, traumatic AVF between the right superficial temporal artery and right retromandibular vein, treated with minimally invasive endovascular embolization by the interventional radiology team. This case report highlights the diagnosis of a traumatic AVF in the pre-auricular region and multi-specialty management of an early complication of minimally invasive maxillofacial surgery.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139262110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-14DOI: 10.1177/27325016231212094
J. James, N. Seyidova, Evans Takyi, Olachi O. Oleru, Peter J. Taub
Despite improvements in microsurgical techniques and broad application of free tissue transfer for reconstruction in the adult population, there is currently a paucity of literature regarding microsurgical reconstruction in the pediatric population, notably a limited number of case series evaluating outcomes following head and neck reconstruction. A retrospective analysis of National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2015 to 2020 was performed. Pediatric patients undergoing head and neck reconstruction with microvascular muscle and fasciocutaneous flaps were identified using Current Procedural terminology codes (CPT). Multivariate logistic regressions were conducted to assess postoperative outcomes of interest. A total of 120 head and neck free flap reconstructions were performed in the pediatric population. Most free flaps were microvascular muscle (n = 82, 68%) followed by fasciocutaneous (n = 38, 32%) flaps. The surgical complication rate was 8% (n = 9) and was primarily due to wound infection 6% (n = 7), whereas medical related complication rate was 14% (n = 17) with majority of patients requiring blood transfusion 12% (n = 14). The median length of stay was 4 days, and ventilator dependence was found to be significantly different among microvascular free flap types. Patients with underweight BMI and ASA Class >2 had higher odds (OR 59.7 and 17.0, P < .05 respectively) of developing any complication for microvascular muscle flaps. Analysis of a national cohort of pediatric patients revealed a low flap-related complication rate. Although free flap reconstruction in the pediatric population is technically demanding, microsurgical free tissue transfer in this population is safe and should be considered if indicated.
{"title":"Microvascular Soft Tissue Reconstruction Outcomes and Risk Factors in Pediatric Patients Undergoing Head and Neck Reconstruction","authors":"J. James, N. Seyidova, Evans Takyi, Olachi O. Oleru, Peter J. Taub","doi":"10.1177/27325016231212094","DOIUrl":"https://doi.org/10.1177/27325016231212094","url":null,"abstract":"Despite improvements in microsurgical techniques and broad application of free tissue transfer for reconstruction in the adult population, there is currently a paucity of literature regarding microsurgical reconstruction in the pediatric population, notably a limited number of case series evaluating outcomes following head and neck reconstruction. A retrospective analysis of National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2015 to 2020 was performed. Pediatric patients undergoing head and neck reconstruction with microvascular muscle and fasciocutaneous flaps were identified using Current Procedural terminology codes (CPT). Multivariate logistic regressions were conducted to assess postoperative outcomes of interest. A total of 120 head and neck free flap reconstructions were performed in the pediatric population. Most free flaps were microvascular muscle (n = 82, 68%) followed by fasciocutaneous (n = 38, 32%) flaps. The surgical complication rate was 8% (n = 9) and was primarily due to wound infection 6% (n = 7), whereas medical related complication rate was 14% (n = 17) with majority of patients requiring blood transfusion 12% (n = 14). The median length of stay was 4 days, and ventilator dependence was found to be significantly different among microvascular free flap types. Patients with underweight BMI and ASA Class >2 had higher odds (OR 59.7 and 17.0, P < .05 respectively) of developing any complication for microvascular muscle flaps. Analysis of a national cohort of pediatric patients revealed a low flap-related complication rate. Although free flap reconstruction in the pediatric population is technically demanding, microsurgical free tissue transfer in this population is safe and should be considered if indicated.","PeriodicalId":508736,"journal":{"name":"FACE","volume":"18 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139276982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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