Impacted upper third molar surgical removal leads to pseudoaneurysm: A case report highlighting surgical risks

Aim The rate of excessive bleeding in the post‐operative period after third molar extraction is low (less than 0.6%), and even lower in the case of upper molars. We report the case of excessive life‐threatening bleeding 2 weeks after an upper third molar extraction that had an intraoperative complication with a displacement of the molar into the maxillary sinus. Materials and methods An initial CT scan showed only postsurgical changes of tooth extraction, and a small contrast agent extravasation (measuring 5 mm). An angiogram was done to locate the origin of the bleeding, and a pseudoaneurysm was located in the right superior alveolar artery. The patient was treated by embolization with coils, with no subsequent episodes of bleeding. Results Pseudoaneurysms of branches of the external carotid artery system are rare, and even more rare after dental or oral surgery (only five cases published to date). Endovascular treatment is the treatment of choice, as it is minimally invasive as well as being selective. Conclusion The rate of traumatic pseudoaneurysm of branches of the ECA is low; however, in order to avoid severe consequences, a correct diagnosis as early as possible is essential for a proper management.