Life-threatening bleeding in a facial fracture

Life-threatening bleeding in facial fractures is considered rare, and most reports do not recommend a precise treatment guideline. Although various me thods have been suggested, they are unpredictable in efficacy and may lead to irreversible shock. To avoid irreversible shock, early detection and cor rect, effective treatment are mandatory. The authors report a patient who p resented with a complex midface fracture after falling on June 23, 1999. Li fe-threatening oronasal bleeding developed 1 hour after arriving at the eme rgency room, Initial nasal packing failed to stop the nasal bleeding. After resuscitation, the patient's vital signs were stable but bleeding persiste d. Angiography showed diffuse extravasation of contrast medium over the ter ritory of the right internal maxillary artery. Embolization was performed s uccessfully to stop the bleeding. The authors review the literature regardi ng the incidence, diagnosis, and treatment of life-threatening facial fract ure. In the literature, the lack of a precise definition leads to various r esults by various treatments. The authors have formulated a succinct treatm ent guideline. They favor angiographic embolization as the first choice of treatment when tight nasal and/or oral packing fails.