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

BACKGROUND: Pseudoaneurysms 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. CONCLUSIONS: PLAs 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.