Masseteric artery pseudoaneurysm: A rare complication in orthognatic surgery

Pseudoaneurysm rarely develops after orthognathic surgery, and can cause symptoms such as facial swelling, delayed bleeding, and development of a pulsatile soft mass. The aim of this report is to highlight a case of a masseteric artery pseudoaneurysm following orthognatic surgery, describing the possible while rare occurrence and its treatment. At the ninth postoperative day, persistent facial swelling and bleeding from the intraoral surgical wounds and nose occurred, followed by a syncope. Support therapy was administered, and an Angio-CT was requested. The results of the scans raised suspicion of the presence of a pseudoaneurysm. After the stabilization of the clinical picture a therapeutic angiography was performed. A pseudoaneurysmatic dilatation was documented in the distal portion of the left masseteric artery and was promptly excluded from the main circle. This artery derived, as an anatomical variant, from a common branch originating from the internal maxillary artery. While this complication is more commonly reported in traumatology, in cases of suspicious intraoperative bleeding, persistent facial swelling, and late-onset nasal-oral hemorrhage, pseudoaneurysms of the maxillofacial district should be considered as a possible complication of orthognatic surgery.