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CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2258-2586
Pediatric/Craniomaxillofacial/Head & Neck: Case Report

Neglected Superior Ophthalmic Vein Enlargement before Delayed Symptom of Carotid-Cavernous Fistula in a Blowout Fracture: A Case Report and Literature Review

Sunkyu Park 
1   Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
,
Inhoe Ku 
1   Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
,
Ji-Ung Park 
1   Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Abstract

Carotid-cavernous fistula (CCF) is a rare condition. However, it should be suspected when there are traumatic facial fractures, because if not diagnosed, it can lead to permanent damage such as blindness. Traumatic CCF often presents delayed symptoms, and delayed diagnosis without prompt treatment can lead to permanent injuries in optic and cranial nerves III, IV, V, and VI as well as intracranial hemorrhage. The routine initial modality for patients with suspected facial bone fractures is noncontrast computed tomography (CT) to identify any fracture lines and check for intracranial hemorrhage. We report a post-traumatic CCF case with a 4-day symptom delay, where left superior ophthalmic vein (SOV) enlargement was observed on the routine noncontrast facial CT with ipsilateral orbital wall fracture. When the patient first presented to the emergency room (ER), we did not detect vein enlargement on CT. Afterwards, the patient developed delayed symptoms of CCF and was readmitted to the ER. When we reanalyzed the first CT scan, an enlarged SOV was confirmed. The diagnosis was confirmed via magnetic resonance imaging angiography, and the patient was successfully treated with embolization of the fistula. Thus, we recommend reviewing ophthalmic vein enlargement that is readily identifiable through noncontrast CT for patients injured by craniofacial trauma to suspect the presence of delayed CCF at their initial presentation.

Keywords

carotid-cavernous fistula - superior ophthalmic vein - orbital wall fracture

Authors' Contributions

Conceptualization : J.U.P. Data curation : S.P., I.K. Visualization : S.P., I.K. Writing - original draft : S.P. Writing - review & editing : J.U.P. All authors read and approved the final manuscript.


Ethical Approval

The study was approved for exemption by the Institutional Review Board of Seoul National University Boramae Hospital (IRB exemption No. 30-2019-10)


Patient Consent

The patient provided written informed consent for the publication and the use of their images.




Publication History

Received: 21 February 2023

Accepted: 28 January 2024

Accepted Manuscript online:
31 January 2024

Article published online:
14 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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