Massive, Spontaneous Facial Hematoma in a Neurofibromatosis Type 1 Patient

Peter F. Svider, Chirag R. Patel, Sangeeta Lamba, Chirag Gandhi, Soly Baredes, Robert W. Jyung

Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey,New Jersey Medical School, Newark, USA.
Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, USA.
Department of Otolaryngology—Head & Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, USA.

DOI: 10.4236/ijohns.2013.21006                

Abstract

Significant hemorrhage in Neurofibromatosis Type 1 (NF-1) patients occurs infrequently, but has potentially devastateing consequences when occurring in the head and neck region. There have been no prior reports of patients with hemodynamically significant, rapidly-expanding lesions into a neurofibroma in the head and neck region without preceding trauma. This case describes the management of a spontaneous, rapidly expanding facial hematoma in an NF-1 patient with an extensive facial and skull base plexiform neurofibroma. The patient underwent angioembolization of his left external carotid artery prior to operative management. The strategies utilized can be extended to management of facial hematomas arising from more common situations such as fractures, lacerations, and pseudoaneursyms, along with bleeding from subacute conditions like other head and neck cancers.

Keywords

Neurofibromatosis Type I; Facial Hematoma; Hemorrhage; Spontaneous Hemorrhage

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	B. R. Korf, “Diagnosis and Management of Neurofibromatosis Type 1,” Current Neurology and Neuroscience Reports, Vol. 1, No. 2, 2001, pp. 162-167. doi:10.1007/s11910-001-0012-z
[2]	C. Nopajaroonsri and A. A. Lurie, “Venous Aneurysm, Arterial Dysplasia, and Near-Fatal Hemorrhages in Neurofibromatosis Type 1,” Human Pathology, Vol. 27, No. 9, 1996, pp. 982-985. doi:10.1016/S0046-8177(96)90229-4
[3]	T. C. Tung, Y. R. Chen, K. T. Chen, C. T. Chen and R. Bendor-Samuel, “Massive Intratumor Hemorrhage in Facial Plexiform Neurofibroma,” Head & Neck, Vol. 19, No. 2, 1997, pp. 158-162. doi:10.1002/(SICI)1097-0347(199703)19:2<158::AID-HED13>3.0.CO;2-9
[4]	J. E. Rasko, K. N. North, E. J. Favaloro, L. Grispo and M. C. Berndt, “Attenuated Platelet Sensitivity to Collagen in Patients with Neurofibromatosis Type 1,” British Journal of Haematology, Vol. 89, No. 3, 1995, pp. 582-588. doi:10.1111/j.1365-2141.1995.tb08367.x
[5]	L. Lessard, A. Izadpanah and H. B. Williams, “Giant Thoracic Neurofibromatosis Type 1 with Massive Intratumoral Haemorrhage: A Case Report,” Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS, Vol. 62, No. 9, 2009, pp. e325-e329. doi:10.1016/j.bjps.2007.10.071
[6]	M. Tsutsumi, K. Kazekawa, A. Tanaka, et al., “Rapid Expansion of Benign Scalp Neurofibroma Caused by Massive Intratumoral Hemorrhage—Case Report,” Neurologia Medico-Chirurgica, Vol. 42, No. 8, 2002, pp. 338-340. doi:10.2176/nmc.42.338
[7]	K. T. S. Kumakiri, “Neurofibromatosis with Massive Facial Hematoma,” Otolaryngology—Head and Neck Surgery (Tokyo), Vol. 75, No. 7, 2003, pp. 473-476.
[8]	Y. F. Chen, Y. C. Lo, W. C. Lin, et al., “Transarterial Embolization for Control of Bleeding in Patients with Head and Neck Cancer,” Official Journal of American Academy of Otolaryngology—Head and Neck Surgery, Vol. 142, No. 1, 2010, pp. 90-94. doi:10.1016/j.otohns.2009.09.031
[9]	Z. H. Baqain, C. Thakkar and N. Kalavrezos, “Superselective Embolization for Control of Facial Haemorrhage,” Injury, Vol. 35, No. 4, 2004, pp. 435-438. doi:10.1016/j.injury.2003.09.001
[10]	J. J. Borsa, A. B. Fontaine, J. M. Eskridge, J. K. Song, E. K. Hoffer and A. A. Aoki, “Transcatheter Arterial Embolization for Intractable Epistaxis Secondary to Gunshot Wounds,” Journal of Vascular and Interventional Radiology: JVIR, Vol. 10, No. 3, 1999, pp. 297-302. doi:10.1016/S1051-0443(99)70034-5