LAUSR

INTRODUCTION Aneurysms of the external carotid artery (ECA) and its branch vessels are rare vascular lesions with potentially devastating consequences. Proximal facial artery aneurysms are relatively uncommon. We provide a provide a pooled data analysis of all reported cases of proximal facial artery true aneurysms without evidence of trauma, as well as all published cases of aneurysms and pseudoaneurysms of the ECA and its branch vessels. EVIDENCE ACQUISITION We conducted a systematic review of the literature searching multiple databases for reports to identify relevant papers. EVIDENCE SYNTHESIS We report the case of a 63-year-old patient who presented to us with a digital subtraction angiography-confirmed aneurysm emanating from the proximal right facial artery with no apparent history of trauma. Only five cases of proximal facial artery true aneurysm have been reported without evidence of trauma. We also provide a pooled data analysis of 810 published cases of aneurysms and pseudoaneurysms of the ECA and its branch vessels. Moreover, we reviewed current treatment strategies and surgical approaches to the true and pseudo aneurysms of the ECA. Finally, we suggest a grading system and treatment protocol for theses aneurysms. Finally, we provided a comprehensive grading system for the management of these aneurysms. CONCLUSIONS While we can follow small asymptomatic true ECA aneurysms, pseudoaneurysms of the ECA and its branches, once diagnosed, may require treatment to prevent rapid expansion, which may in turn lead to rupture, cranial nerve impingement, pain, or cosmetic disfigurement.