PMC3740618_01
(a) Selective catheterization of the external carotid artery to just proximal to the facial artery demonstrates faint Onyx-18 cast of the ipsilateral internal maxillary artery (b) Superselective catheterization of the inferior division of the facial artery using a microcatheter with subsequent Onyx-18 embolization. Onyx-18 cast of the ipsilateral internal maxillary artery is readily visible (c) Superselective catheterization of the superior division of the Facial artery using a microcatheter with subsequent Onyx-18 embolization (d) Nonsubtracted view with roadmap guidance showing Onyx-18 casts within the Internal Maxillary and Facial arteries
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F1
After allowing the cap to solidify, the vessels were embolized with 0.8 cc of Onyx-18 over a period of minutes [Figure 1].
Photograph of patient on postembolization day 4, demonstrating hyperpigmented plaque on her left nasal ala and cheek with surrounding erythema
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F2
On postembolization day 3, the patient noticed a hyperpigmented patch on her left cheek that appeared, prompting dermatologic evaluation [Figure 2].
(a) Low magnification hematoxylin and eosin stain of biopsy specimen showing epidermis, dermis, and subcutaneous tissues with dermoepidermal separation (b) Higher magnification demonstrates necrosis of hair follicles (c) Higher magnification demonstrates necrosis of eccrine glands
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F3
Examination of the biopsy revealed full-thickness epidermal necrosis, as well as necrosis of the upper and mid-dermis, follicles, sebaceous glands, and eccrine glands [Figure 3].