Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-22T14:23:20.209Z Has data issue: false hasContentIssue false
  • English
  • Français

Post-tonsillectomy pseudoaneurysm: an underestimated entity?

Published online by Cambridge University Press:  18 September 2009

J P Windfuhr ,
A M Sesterhenn ,
G Schloendorff  and
B Kremer
J P Windfuhr*
Affiliation:
Department of ORL Malteser Krankenhaus St. Anna Duisburg, Germany
A M Sesterhenn
Affiliation:
Philipps University of Marburg, Marburg, Germany
G Schloendorff
Affiliation:
University Hospital of Aachen, Germany
B Kremer
Affiliation:
University Hospital Maastricht, The Netherlands
*
Address for correspondence: Dr Jochen P Windfuhr, Department of Otorhinolaryngology, Head and Neck Surgery, St Anna Hospital, Albertus Magnus Str 33, 47259 Duisburg, Germany. Fax: +49 203 755 1266 E-mail: jochen.windfuhr@malteser.de
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify patients undergoing arteriography to verify vascular complications of tonsillectomy, with an emphasis on pseudoaneurysm.

Patients and methods:

We undertook a retrospective analysis of the case records of 8837 patients who had undergone tonsillectomy between 1988 and 2004 at our institution, together with a review of expert reports written for professional boards and civil courts as well as personal experiences or communication. We also conducted a literature review using the PubMed database.

Results:

We identified seven cases with vascular abnormalities. In addition, we identified three cases of pseudoaneurysm formation, involving two children and one adult patient, with bleeding 21, 36 and 58 days after tonsillectomy. Successful management included embolisation (two patients) and revision surgery (one patient).

Conclusion:

Post-tonsillectomy pseudoaneurysm formation is extremely rare and unrestricted by age. Correct diagnosis depends largely on a high index of clinical suspicion. Delayed and repeated episodes of gushing haemorrhage with spontaneous cessation appear to be a significant clinical marker. Immediate arteriography, with simultaneous embolisation, is highly recommended. The lingual artery is the most commonly involved vessel.

Keywords

TonsillectomyPost-tonsillectomy HemorrhagePseudoaneurysmComplicationEpisodic Bleeding
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 1 , January 2010 , pp. 59 - 66
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Sholevar, J, Hunsicker, R, Stools, S. Arteriography in posttonsillectomy hemorrhage. Arch Otolaryngol 1972;95:581–3CrossRefGoogle Scholar
2 Paulsen, F, Tillmann, B, Christofides, C, Richter, W, Koebke, J. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat 2000;197:373–81CrossRefGoogle Scholar
3 Ozgur, Z, Celik, S, Govsa, F, Aktug, H, Ozgur, T. A study of the course of the internal carotid artery in the parapharyngeal space and its clinical importance. Eur Arch Otorhinolaryngol 2008;264:1483–9CrossRefGoogle Scholar
4 Weibel, J, Fields, W. Tortuosity, coiling and kinking of the internal carotid artery. Neurology 1965;15:7–18CrossRefGoogle ScholarPubMed
5 Blum, DJ, McCaffrey, TV. Septic necrosis of the internal carotid artery: a complication of peritonsillar abscess. Otolaryngol Head Neck Surg 1983;91:114–18CrossRefGoogle ScholarPubMed
6 Conrad, R, Krokenberger, M, Hufen, V, Harder, T. Pseudoaneurysm of the internal carotid artery following a peritonsillar abscess [in German]. Aktuelle Radiol 1994;4:109–11Google ScholarPubMed
7 Girishkumar, HT, Sivakumar, M, Andaz, S, Santosh, V, Solomon, R, Brown, M. Pseudo-aneurysm of the carotid bifurcation secondary to radiation. J Cardiovasc Surg (Torino) 1999;40:877–8Google ScholarPubMed
8 Pourhassan, S, Grotemeyer, D, Fokou, M, Heinen, W, Balzer, K, Ramp, U et al. Extracranial carotid arteries aneurysms in children: single-center experiences in 4 patients and review of the literature. J Pediatr Surg 2007;42:1961–8CrossRefGoogle ScholarPubMed
9 Maurizi, M, Almadori, G, Paludetti, G, Ottaviani, F, Loschi, A. Pseudo aneurysm of the external carotid artery: report of a case. Int J Pediatr Otorhinolaryngol 1985;8:263–9CrossRefGoogle ScholarPubMed
10 Windfuhr, JP, Schloendorff, G, Sesterhenn, AM, Kremer, B. Eur Arch Otorhinolaryngol 2009 Jan 31 (EPub ahead of print)Google Scholar
11 DeFatta, RJ, Verret, DJ, Bauer, P. Extracranial internal carotid artery pseudoaneurysm. Int J Pediatr Otorhinolaryngol 2005;69:1135–9CrossRefGoogle ScholarPubMed
12 Veyssier, P, Biou, C, Langman, JC, Vilain, G. An unusual complication after tonsillectomy. Rev Stomatol Chir Maxillofac 1976;77:861–4Google ScholarPubMed
13 Heyn, G, Metz, L, Olthoff, G. Aneurysm of the extracranial internal carotid artery [in German]. Zentralbl Chir 1986;111:1312–20Google ScholarPubMed
14 van Cruijsen, N, Gravendeel, J, Dikkers, FG. Severe delayed posttonsillectomy haemorrhage due to a pseudoaneurysm of the lingual artery. Eur Arch Otorhinolaryngol 2008;265:115–17CrossRefGoogle ScholarPubMed
15 Laage, G, Beuthner, D. Carotid aneurysm following tonsillectomy and its plastic treatment [in German]. HNO 1972;20:152–3Google ScholarPubMed
16 Tovi, F, Leiberman, A, Hertzanu, Y, Golcman, L. Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy. Int J Pediatr Otorhinolaryngol 1987;13:69–75CrossRefGoogle ScholarPubMed
17 Walshe, P, Ramos, E, Low, C, Thomas, L, McWilliams, R, Hone, S. An unusual complication of tonsillectomy. Surgeon 2005;3:296–8CrossRefGoogle ScholarPubMed
18 Haynes, DS, Schwaber, MK, Netterville, JL. Internal carotid artery aneurysms presenting as neck masses. Otolaryngol Head Neck Surg 1992;107:787–91CrossRefGoogle ScholarPubMed
19 Yoshizaki, T, Teranishi, S, Matsui, O, Furukawa, M. Internal carotid artery aneurysm presenting as a large pharyngeal mass. Ann Otol Rhinol Laryngol 2000;109:690–2CrossRefGoogle ScholarPubMed
20 Unal, OF, Hepgül, KT, Turantan, MI, Bozboga, M, Yazicioglu, E. Extracranial carotid artery aneurysm in a child misdiagnosed as a parapharyngeal abscess: a case report. J Otolaryngol 1992;21:108–11Google Scholar
21 Mokri, B, Piepgras, DG, Sundt, TMJ, Pearson, BW. Extracranial internal carotid artery aneurysms. Mayo Clin Proc 1982;57:310–21Google ScholarPubMed
22 Hadfield, PJ, Gane, SB, Leighton, SE. Epistaxis due to traumatic internal carotid artery aneurysm. Int J Pediatr Otorhinolaryngol 2002;66:193–6CrossRefGoogle ScholarPubMed
23 van Rensburg, LC. Aneurysm of the internal carotid artery presenting as a peritonsillar abscess. S Afr Med J 1964;38:567–72Google Scholar
24 Hsu, RF, Su, CY, Chien, CY, Liu, CM. Internal carotid artery aneurysm presenting as an unusual nasopharyngeal mass. Ann Otol Rhinol Laryngol 1998;107:536–9CrossRefGoogle ScholarPubMed
25 Hertzanu, Y, Tovi, F. Radiology case of the month. Aberrant internal carotid artery manifesting as a pharyngeal mass. J Otolaryngol 1992;21:294–6Google ScholarPubMed
26 Liu, TH, Filipp, GD. Giant internal carotid artery aneurysm masquerading as a paranasal sinus tumor. AJNR Am J Neuroradiol 1986;7:975–6Google ScholarPubMed
27 Ferry, DJJ, Kempe, L. False aneurysm secondary to penetration of the brain through orbitofacial wounds. Report of two cases. J Neurosurg 1972;36:503–6CrossRefGoogle ScholarPubMed
28 Beale, PJ. Late development of a false aneurysm of the common carotid artery. Br J Surg 1971;58:76–8CrossRefGoogle ScholarPubMed
29 DiStefano, JF, Maimon, W, Mandel, MA. False aneurysm of the lingual artery. J Oral Surg 1977;35:918–20Google ScholarPubMed
30 Hertzanu, Y, Hirsch, M, Tovi, F. Pseudoaneurysm of internal carotid artery secondary to tonsillectomy: combined radiologic and surgical treatment. Cardiovasc Intervent Radiol 1987;10:147–9CrossRefGoogle ScholarPubMed
31 Mitchell, RB, Pereira, KD, Lazar, RH, Long, TE, Fournier, NF. Pseudoaneurysm of the right lingual artery: an unusual cause of severe hemorrhage during tonsillectomy. Ear Nose Throat J 1997;76:575–6CrossRefGoogle ScholarPubMed
32 Simoni, P, Bello, JA, Kent, B. Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization. Int J Pediatr Otorhinolaryngol 2001;59:125–8CrossRefGoogle ScholarPubMed
33 Weber, R, Keerl, R, Hendus, J, Kahle, G. An emergency situation: traumatic aneurysm in head-neck-region [in German]. Laryngorhinootologie 1993;72:86–90CrossRefGoogle Scholar
34 Maurer, J, Beck, C, Mann, W. Aneurysms of the lingual artery as a cause of recurrent late hemorrhage following tonsillectomy [in German]. Laryngorhinootologie 1989;68:301–3CrossRefGoogle ScholarPubMed
35 Menauer, F, Suckfull, M, Stabler, A, Grevers, G. Pseudoaneurysm of the lingual artery after tonsillectomy. A rare complication [in German]. Laryngorhinootologie 1999;78:405–7CrossRefGoogle ScholarPubMed
36 Karas, DE, Sawin, RS, Sie, KC. Pseudoaneursym of the external carotid artery after tonsillectomy. A rare complication. Arch Otolaryngol Head Neck Surg 1997;123:345–7CrossRefGoogle ScholarPubMed
37 Hoff, M, Graumuller, S, Pau, HW. Arterial aneurysms as cause of gushing post-tonsillectomy hemorrhage [in German]. Laryngorhinootologie 2005;84:680–2CrossRefGoogle ScholarPubMed
38 Deutsch, MD, Kriss, VM, Willging, JP. Distance between the tonsillar fossa and internal carotid artery in children. Arch Otolaryngol Head Neck Surg 1995;121:1410–12CrossRefGoogle ScholarPubMed
39 Levy, EI, Horowitz, MB, Cahill, AM. Lingual artery embolization for severe and uncontrollable postoperative tonsillar bleeding. Ear Nose Throat J 2001;80:208–11CrossRefGoogle ScholarPubMed
40 Opatowsky, MJ, Browne, JD, McGuirt, WF Jr, Morris, PP. Endovascular treatment of hemorrhage after tonsillectomy in children. AJNR Am J Neuroradiol 2001;22:713–16Google ScholarPubMed
41 McIntosh, DL, Douglas, G, Lee, K, Allen, J, Mahadevan, M. External carotid artery blood supply to the orbit. Int J Pediatr Otorhinolaryngol 2007;71:1623–6CrossRefGoogle Scholar