60 y female - slip and fall in home - no LOC / vomiting / ENT bleed / seizures - hemodynamically stable - swelling over left cheek increasing with time and pulsatile . Interpret the diagnosis and describe further management ?

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AVF. Dulplex scan to rule out. pulsating in nature. murmur can be feel on auscultation. management is ligating the artery or vein. its same we met durins PSA block tear pterygoidal plexus. we give pressure pack immediately otherwise it become so big in minutes. self limiting coz after certain extent no space for extension. still duplex scan is helpful. regards

* AVF - ARTERIOVENOUS FISTULA HERE ITS TRAUMATIC AVF
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Pulsating; increasing swelling...a blunt injury s/o Arterial Trauma with internal closed bleeding (ongoing) with Hamatoma.Mostly Or.facial artery...@ risk of injury because of underlying Hard structure I.e.Mandible. OR ??Maxillary sinus injury.

Swelling developed after fall Its traumatic injury to left cheek Start antiinflamatory analgesic Ice pack fomantation If swelling not reduced then go ahead with 3D CT face to rule out fracture

DIAGNOSTIC IMAGING Duplex imaging confirms the presence of an AVF by demonstrating low-resistance flow in the enlarged afferent artery, a turbulent, high-velocity flow spectrum at the fistula site and a high-velocity, arterialized waveform in dilated, thick-walled draining veins Computed tomographic and magnetic resonance angiography can provide images of the anatomy of the arteriovenous communication, typically with early contrast filling in the vein during the arterial phase. Detailed anatomical views of the involved vessels and the site and size of the AVF is helpful when making decisions about the best treatment option. Digital catheter angiography is usually performed immediately before treatment, or it may be undertaken diagnostically if noninvasive imaging is not sufficient for diagnosis or if a detailed vascular study is required to plan treatment. Catheter angiography can show flow dynamics and the precise anatomy of AVF communication, often uncovering previously unsuspected involvement of vessels or collaterals and variant anatomy. Selective catheter angiography of individual branch vessels and high frame rates are usually required

# of maxillary bone with collection of blood in maxillary sinus. .change of colour of skin suggest trauma.

bleeding in maxillary sinus come through nose too.... isn't it sir?
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fractured orbit with maxillary sinus wall fractures with collection of haematoma... note.. does pt on antiplatelate drugs...

No fractures in facial CT No comorbidities
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X Ray skull ap Lat & OPG to rule out fracture & local haematoma & bleed CT scan for internal neurological complications management will depend upon level conscious but other wise Dialntin 100 mg TDS local application of magsulph pack Tab dimox 200 Bd Inj dexona 8mg TDS Antiboitics & observation & appropriate surgical treatment can be considered

May be due to traumatic vascular injury with or without fracture of maxillary bone. scan is needed to confirm. ice fomentation and Ligation of bleeder is management

AV fistula, it's scientific.

traumatic av fistula

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