Abstract
Introduction: Orthognathic surgery such as bilateral sagittal split osteotomy is an extensive procedure that brings changes in the arrangement of bone and myofascial continuum. Although rarely, but extensive retraction forces can sometimes exceed elasticity of vasculature embedded in the myofascial system. A minor rupture in the wall of the artery leads to blood extravasation, the tightly arranged perivascular tissues in the myofascial system forms the walls of the aneurysmal sac. Pseudoaneurysm aneurysm (PA) in the head and neck region can cause rupture, thrombosis, fistula formation, tinnitus, epistaxis, cosmetic disfigurement or neurologic deficit due to pressure on surrounding structures.
Vascular tinnitus due to PA is seen in the facial artery and superior labial artery mostly due to atherosclerosis and AV malformations like aneurysms. The diagnosis is by CTA and MRA. Embolization is one of the Treatment modality for aneurysm and tinnitus may completely get resolved post embolectomy
Case report: A 23-year-old female presented to the ENT clinic for complaint of tinnitus since six months. A notable pulsatile swelling was observed in the right submandibular area. The case referred to maxillofacial surgery clinic. History revealed that the patient had undergone bilateral sagittal split osteotomy for mandibular setback three years before, MRI Angiogram performed showed pseudoaneurysm of facial artery that might be related to orthognathic surgery.

Key words: pseudoaneurysm, myofascial continuum, bilateral sagittal split osteotomy, orthognathic surgery