Pseudoaneurysms of the lingual artery: two case reports and a systematic review.

backgroundPseudoaneurysms of the lingual artery (PLAs) are rare vascular lesions that may develop secondary to trauma, infection, or head and neck surgical and oncologic procedures. Although uncommon, they constitute a potentially life-threatening cause of oropharyngeal hemorrhage. Their heterogeneous etiologies and variable presentations contribute to the absence of standardized management guidelines. PURPOSE: To provide a comprehensive analysis of the diagnosis and treatment of published PLAs, alongside the description of two additional clinical cases. DATA SOURCES: A systematic review of the literature was conducted according to PRISMA guidelines and using the PubMed and Scopus databases. STUDY SELECTION: Were included 45 published cases comprising 55 patients with PLAs, plus two novel unreported cases. DATA ANALYSIS: Data regarding patient demographics, etiology, clinical presentation, imaging, aneurysm location, treatment strategy, and outcomes were extracted and analysed. DATA SYNTHESIS: The mean patient age was 37.6 years, showing a bimodal distribution: younger patients commonly presented with post-tonsillectomy or traumatic pseudoaneurysms, while older individuals were more often affected after malignancy or oncologic surgery. Haemorrhage was the primary presentation (75.4%) and 38.6% of all cases followed tonsillectomy. Four cases were asymptomatic. Most lesions arose from the main trunk of the lingual artery (42.1%) or unspecified segments of the vessel (36.8%). Endovascular treatment (EVT) was successful in 77.2% of cases, in which parent vessel occlusion (PVO) proved to be the most reliable and effective technique (88.6%). Ultrasound-guided percutaneous thrombin injection was effective in two patients. EVT failed in two cases due to catheterization difficulties and arterial dissection. Mortality was low (3.5%). LIMITATIONS: Most data derive from heterogeneous case reports and series with limited sample sizes and variable reporting standards.

conclusionsPLAs are rare but potentially life-threatening causes of oropharyngeal bleeding. Prompt diagnosis and EVT, particularly PVO, are essential for successful management. Extensive collateral circulation supports safe vessel exclusion. Multidisciplinary coordination optimizes patient outcomes.