Blunt Vascular Injuries of the Face and Scalp: Systematic Review and Introduction of a Grading Scheme and Treatment Algorithm.

Introduction: Branches of the internal and external carotid arteries supplying the scalp and face are vulnerable to injury from blunt trauma and penetrating injuries, especially over bony structures. Blunt trauma can lead to vessel dissection, pseudoaneurysm, or transection with extravasation. These injuries often present days to months post-trauma unless accompanied by avulsion with hemorrhage. Compounding the challenge, additional injuries are rare. Unlike blunt cerebrovascular injuries, there is no standardized grading system for diagnosing blunt cephalovascular injuries.

Methods: A systematic review of literature up to January 2024 identified reports on blunt injuries to branches of the carotid arteries supplying facial and scalp regions. Focus was on vascular injury type and treatment regimen, along with patient demographics and associated injuries. A novel grading system was proposed, and an analysis of conglomerated data was performed.

Results: Of 99 abstracts, 74 articles met inclusion criteria. The review included 111 patients, with 91 (81.9%) male and an average age of 51.4±27.8 years. The superficial temporal artery was most commonly injured (89, 80.2%). Although imaging was not required in many cases, computed tomography angiography (CTA) identified 65 (58.6%) cases. Pseudoaneurysm was the most common injury (101, 91.0%), with surgical ligation or endovascular embolization being the primary treatments.

Conclusions: Blunt cephalovascular trauma is rare and often missed due to subtle symptoms unless there is transection. High suspicion for injury warrants a CTA. Surgical ligation, resection, or embolization typically resolves symptoms. Plastic surgeons should be prepared to manage these injuries during facial trauma consultations.