Key Clinical Message
Although uncommon, patients should be advised that soft tissue necrosis may be a complication of arterial embolization used for treatment of epistaxis.
Keywords: Complication, embolization, epistaxis, necrosis, sphenopalatine artery
Question: Arterial embolization is an established treatment of refractory epistaxis; what uncommon complication of sphenopalatine artery emboliztaion is depicted in Fig. 1?
Figure 1.
Clinical photograph showing ulceration of left hard palate.
Answer: The image demonstrates necrosis and ulceration of the palatal mucosa. Tissue loss secondary to arterial embolization is rare in the head and neck due to the extensive collateral blood supply of the region 1. Necrosis involving the nasal septum and facial skin has also been reported therefore patients should be warned during the consent process.
Commonly used agents include gelfoam, polyvinyl alcohol, platinum coils and as in this case, tris‐acryl gelatin. Particles <150 μm in size may increase unwanted ischemic complications due to uncontrolled particle spread via vascular anastamoses 2.
Conflict of Interest
None declared.
Clinical Case Reports 2016; 4(4): 453
References
- 1. Guss, J. , Cohen M. A., and Mirza N.. 2007. Hard palate necrosis after bilateral internal maxillary artery embolization for epistaxis. Laryngoscope 117:1683–1684. [DOI] [PubMed] [Google Scholar]
- 2. Willems, P. W. A. , Farb R. I., and Agid R.. 2009. Endovascular treatment of epistaxis. Am. J. Neuroradiol. 30:1637–1645. [DOI] [PMC free article] [PubMed] [Google Scholar]