Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.12015
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
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 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.
Radiologists should be aware that the PT of the APhA can be a bleeding source, which has a potential connection with the SPA.
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.