Carotid artery-cavernous sinus fistula is a lesion most often associated with massive head trauma. The maxillofacial surgeon must be able to diagnose this major complication of head trauma, use proper diagnostic techniques, and initiate appropriate therapeutic regimens. The symptoms of pulsatile headache, bruit, and visual change accompany the physical findings of bruit, conjunctival engorgement, chemosis, proptosis, and ophthalmoplegia. A number of procedures have been devised to correct this difficult lesion, ranging from cervical ligation to balloon occlusion. Two cases of carotid artery-cavernous sinus fistula are reported in detail, documenting clinical findings, treatment, and long-term sequelae. Although surgical treatment is not within the scope of this specialty, the otolaryngologist must understand the vascular dynamics and surgical procedures related to this traumatic lesion.