Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 12015-12021
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.12015
Transcatheter arterial embolization for traumatic injury to the pharyngeal branch of the ascending pharyngeal artery: Two case reports
Daisuke Yunaiyama, Yuki Takara, Takehiro Kobayashi, Mika Muraki, Taro Tanaka, Mitsuru Okubo, Toru Saguchi, Motoki Nakai, Kazuhiro Saito, Kiyoaki Tsukahara, Yuri Ishii, Hiroshi Homma
Daisuke Yunaiyama, Yuki Takara, Takehiro Kobayashi, Mika Muraki, Taro Tanaka, Mitsuru Okubo, Toru Saguchi, Motoki Nakai, Kazuhiro Saito, Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
Kiyoaki Tsukahara, Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
Yuri Ishii, Hiroshi Homma, Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
Author contributions: Yunaiyama D and Takara Y designed the report; Kobayashi T, Muraki M, Tsukahara K, Ishii Y, Homma H and Tanaka T collected the patients’ clinical data; Yunaiyama D, Okubo M, Saguchi T, Nakai M and Saito K analyzed the data and wrote the paper; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients’ for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daisuke Yunaiyama, MD, PhD, Senior Lecturer, Department of Radiology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku 160-0023, Japan. yuunai@tokyo-med.ac.jp
Received: August 1, 2022
Peer-review started: August 1, 2022
First decision: September 5, 2022
Revised: September 13, 2022
Accepted: October 17, 2022
Article in press: October 17, 2022
Published online: November 16, 2022
Processing time: 98 Days and 22.1 Hours
Abstract
BACKGROUND

The ascending pharyngeal artery (APhA) comprises the pharyngeal trunk (PT) and neuromeningeal trunk. The PT feeds the nasopharynx and adjacent tissue, which potentially connects with the sphenopalatine artery (SPA), branched from the internal maxillary artery (IMA). Due to its location deep inside the body, the PT is rarely injured by trauma. Here, we present two cases that underwent transcatheter arterial embolization (TAE) of the PT of the APhA due to trauma and iatrogenic procedure.

CASE SUMMARY

Case 1 is a 49-year-old Japanese woman who underwent transoral endoscopy under sedation for a medical check-up. The nasal airway was inserted as glossoptosis occurred during sedation. Bleeding from the nasopharynx was observed during the endoscopic procedure. As the bleeding continued, the patient was referred to our hospital for further treatment. Contrast-enhanced computed tomography (CT) demonstrated extravasation in the nasopharynx originating from the right Rosenmuller fossa. TAE was performed and the extravasation disappeared after embolization. Case 2 is a 28-year-old Japanese woman who fell from the sixth floor of a building and was transported to our hospital. Contrast-enhanced CT demonstrated a complex facial fracture accompanying extravasation in the left pterygopalatine fossa to the nasopharynx. Angiography demonstrated an irregular third portion of the IMA. As angiography after TAE of the IMA demonstrated extravasation from the PT of the APhA, additional TAE to the artery was performed. The bleeding stopped after the procedure.

CONCLUSION

Radiologists should be aware that the PT of the APhA can be a bleeding source, which has a potential connection with the SPA.

Keywords: Arteries; Catheters; Hemorrhage; Injury; Trauma; Case report

Core Tip: The pharyngeal trunk (PT) of the ascending pharyngeal artery (APhA) feeds the nasopharynx and adjacent tissue, which potentially has a connection with the sphenopalatine artery (SPA) branched from the internal maxillary artery. The PT is rarely injured due to its position deep inside the body; however, it may be a bleeding source of the nasopharynx in trauma patients. Moreover, the PT of the APhA might be a bleeding source after embolization of the SPA. Radiologists should be aware that the PT of the APhA, which potentially connects with the SPA, can be a bleeding source in patients with trauma.