Intraoperative Haemorrhage from an Atypically Configurated Maxillary Artery in a Patient with Aggressive Chronic Rhinosinusitis with Polyps

Introduction Functional endoscopic sinus surgery is one of the most frequently performed procedures in otorhinolaryngology. Although minimally invasive by nature, complications may occur in 5-30 % of cases, many of which are related to vascular haemorrhage. The latter can be life-threatening under unfavorable circumstances; therefore, a targeted and timely management is mandatory.

Case report We present the case of a 56-year-old female patient with chronic pan-rhinosinusitis and aggressive polyp growth under known NSAID-intolerance affecting the upper airways. During functional endoscopic sinus surgery for the right side, an intraoperative bleeding of a branch from the maxillary artery occurred without direct injury to the posterior maxillary wall. The right maxillary sinus was packed immediately. Secondly, angiography revealed an atypical course of the right maxillary artery with feeding branches form the external as well as the internal carotid artery. While the proximal branch was embolized by the neuroradiologists, the distal branch was not eligible for embolization due to feeders from the internal carotid artery. Consequently, the distal branch required surgical clipping by a transantral approach.

Conclusion The case presented here shows that cases of aggressive Type II inflammation of the paranasal sinuses with extensive polyp growth may confront the surgeon with sudden and marked haemorrhage even without pre-existing conditions in the operative field. Finally, due to the atypical configuration of the bleeding vessel only an interdisciplinary, multi-step approach was able to control this complication with success.

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Publication History

Article published online:
10 June 2020