Kareem O Tawfik1, Jeffrey J Harmon1, Zoe Walters2, Ravi Samy3, Alessandro de Alarcon4, Shawn M Stevens5, Todd Abruzzo2. 1. 1 Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. 2. 2 University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. 3. 3 Division of Otology/Neurotology, Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 4. 4 Center for Pediatric Voice Disorders, Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 5. 5 Arizona Otolaryngology Consultants and Barrow Neurological Institute, Phoenix, Arizona, USA.
Abstract
OBJECTIVES: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. METHODS: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. RESULTS: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. CONCLUSIONS: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.
OBJECTIVES: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. METHODS: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. RESULTS: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. CONCLUSIONS:Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.
Authors: Ahmed Helal; Kunal Vakharia; Waleed Brinjikji; Matthew L Carlson; Colin Lw Driscoll; Jamie J Van Gompel; Michael J Link; Harry Cloft Journal: Interv Neuroradiol Date: 2021-05-26 Impact factor: 1.764