We present the case of a 24-year-old male referred to the maxillofacial surgery department of our institution for evaluation of cleft lip and palate. The patient had no history of interest except for unspecified surgery for his underlying disease years before, and with secondary malar hypoplasia. On physical examination the patient had dysmorphia of the nasal pyramid. Cephalometric analysis and imaging studies including multidetector computed tomography (MDCT) confirmed the presence of maxillary hypoplasia. A 2-phase surgical management was planned based on clinical and radiological findings. In the first phase a LeFort type 1 osteotomy with placement of internal maxillary distractors was performed. After correction of the maxillomandibular relationship, a second phase would probably include extraction of teeth and rehabilitation with dental implants. The first phase of treatment was carried out without immediate surgical complications.
The patient presented 27 days later to the emergency department for epistaxis for which bilateral anterior packing and admission were indicated. It was decided to perform MDCT after intravenous contrast injection (IVC) for vascular study of the facial mass, which revealed a pseudoaneurysm of approximately 8 × 9 × 8 mm (anteroposterior, transverse and craniocaudal diameter) in the right pterygo-palatine fossa with probable origin in the ipsilateral internal maxillary artery.

During admission, the patient presented significant episodes of oral and nasal bleeding with important haemodynamic consequences, for which a subsequent tamponade with Foley catheters was performed. One day later, selective arteriography of the right external carotid artery was performed with therapeutic intent, which confirmed the presence of the pseudoaneurysm and its dependence on the internal maxillary artery. It was decided to perform embolisation in the same intervention with 50% cyanoacrylate glue. The patient tolerated the procedure well and was transferred to the maxillofacial surgery ward. As there were no new bleeding episodes or haemodynamic alterations, 6 days after embolisation, the patient was discharged.