Interdisciplinary management of maxillo-facial haemorrhages

Objectives: Cervico-facial haemorrhages are an indication for surgeon and operative neuroradiologist cooperation. Patient with traumatic vascular lesions, stabilised according to Advanced Trauma Life Support procedures, is entrust to the Maxillo-Facial surgeon to manage the bleeding. Lesions of inaccessible vessels, dangerous for haemorrhagic shock and airways obstruction, are treated according to Damage Control principles to ensure to realize neuroradiologic diagnostic and operative procedures. Methods: Angiography is performed by femoral microcatheterism; if vascular lesion is identified (10% of cases) embolization is performer by use of Enducrilate + Lipiodol 1:3. In case of widespread bleeding with poorly defined origin (90% of cases) the material of choice is Polyvinyl Alcohol particles (150–300 mm). Results: All cases treated to Niguarda Trauma Center Hospital in Milan had a good management of haemorrhages with neuroradiologic diagnostic and operative procedures. The minority of them needed a secondary embolization to treat anastomotic bleeding paths. No ischaemical damage occurred. Conclusion: Evolution of neuroradiologic endovascular procedures offers to Maxillo-Facial Surgeons a mini-invasive alternative to manage life-threatening bleeding refractory to any local haemostatic measures. This kind of treatment is simple, repeatable, counter-indicated only in patients with hypersensivity to iodine. Surgical ligature of neck blood vessel must be avoided because of frequent onset of collateralisation of blood supply. This procedure may exclude neuroradiologic diagnostic and operative procedure