Management of life threatening hemorrhage from facial fracture

Abstract

Persisted bleeding from facial fractures after nasal packing or direct pressure is not common, however if it happens, the mortality rate is very high. The study of the treatment for this group of surviving patients was made to find the guideline for management of these patients. From the period of 1 January 1993 to 31 December 2002, 3756 cases of facial fractures were treated at the Trauma Center, Faculty of Medicine Siriraj Hospital. There were 14 life-threatening hemorrhage cases and 9 patients survived. They were 3 Le Fort fracture, 2 nasal fracture, 1 mandibular fracture and 3 multiple facial fractures. Repacking of nasal cavities was performed and was able to stop bleeding successfully in 2 cases. Three cases required operation and 3 cases had angiography and embolization. One case still bled after operation and needed angiography and embolization. The present study shows that the adequacy of nasal packing or wound compression should be evaluated first. Early operation could stop bleeding in nearly half of the cases. Angiography and embolization can be used alone or adjunct to the operation to control bleeding with good result.