Persistent facial swelling and tinnitus complicating septorhinoplasty.

Septorhinoplasty (SRP) is commonly performed for correcting nasal bony and cartilaginous deformities. Traumatic arteriovenous fistula (AVF) is often seen at specific anatomic locations and has rarely been associated to SRP. We report such an unusual case where an AVF developed from a terminal branch of the facial artery. After septorhinoplasty a patient reported pulsatile tinnitus, starting one day after surgery. Swelling on the left side of the nasal pyramid was still present two weeks after the procedure. Clinically, a traumatic AVF was suspected which was confirmed by subsequent Doppler ultrasound examination and angiography. The lesion had developed an important venous pouch and arterial contribution was from the internal carotid as well as external carotid system bilaterally. Complete resection was done by external approach.