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Four Different Reasons of Subcutaneous Emphysema With or Without Pneumomediastinum and Pneumothorax After Facial Bone Surgery. J Craniofac Surg 2022; 33:e616-e620. [PMID: 35761450 DOI: 10.1097/scs.0000000000008693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In the present study, the authors report rare case series with subcutaneous emphysema with or without pneumomediastinum and pneumothorax after orthognathic and facial bone contouring surgery, compare their clinical and radiologic findings, and suggest precautions. Four patients who showed subcutaneous emphysema on follow up chest X-ray and computed tomography after orthognathic and facial bone contouring surgery were included in the study. In all cases post-op subcutaneous emphysema were detected, however, the aspect and mechanisms of post-op air spread were all different. After the conservative management with administering the O2 by nasal cannula or endotracheal tube, the symptoms were relieved except 1 patient who needed chest tube insertion and further supra-sternal incision. In conclusion, subcutaneous emphysema with or without pneumomediastinum and pneumothorax after orthognathic and facial bone contouring surgery can be occurred by cervical fascia injury or alveolar ruptures. To preventing those complications, traumatic naso-tracheal intubation, excessive positive pressure ventilation, intermaxillary fixation immediate after the surgery, and increase of intra-alveolar pressure of the patients should be avoided.
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Gowans K, Patel M, Lewis K. Surgical Emphysema: A Rare Complication of a Simple Surgical Dental Extraction Without the Use of an Air-Driven Rotor. ACTA ACUST UNITED AC 2017; 44:217-8, 220. [PMID: 29172328 DOI: 10.12968/denu.2017.44.3.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgical emphysema is a rare complication of dental extractions, often associated with the use of high-speed air rotors. This report describes a case of extensive surgical emphysema following a simple surgical extraction of a LL6 under local anaesthetic. There was no use of air-driven handpieces during the procedure. The patient developed extensive surgical emphysema bi-laterally in both cervical neck and facial planes. After prophylactic antibiotics with careful monitoring in a secondary care setting, the patient made a full unremarkable recovery. Clinical relevance: Simple extraction of teeth is a procedure carried out daily by most general dental practitioners. However, the risk of surgical emphysema without the use of high-speed air rotors or instruments using pressurized air/water is not well known or documented.
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Al Shetawi AH, Golden L, Turner M. Anesthetic Complication during Maxillofacial Trauma Surgery: A Case Report of Intraoperative Tension Pneumothorax. Craniomaxillofac Trauma Reconstr 2016; 9:251-4. [PMID: 27516842 DOI: 10.1055/s-0036-1572504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Tension pneumothorax is a life-threatening emergency that requires a high index of suspension and immediate intervention to prevent circulatory collapse and death. Only five cases of pneumothorax were described in the Oral and Maxillofacial Surgery literature. All cases were postoperative complications associated with orthognathic surgery. We report a case of intraoperative tension pneumothorax during a routine facial trauma surgery requiring emergency chest decompression. The possible causes, classification, and reported cases will be presented.
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Affiliation(s)
- Al Haitham Al Shetawi
- Division of Oral & Maxillofacial Surgery, Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Leonard Golden
- Department of Anesthesiology, Jacobi Medical Center, Bronx, New York
| | - Michael Turner
- Division of Oral & Maxillofacial Surgery, Jacobi Medical Center, Bronx, New York
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Johannesma PC, Vonk Noordegraaf A. Pneumomediastinum and pneumopericardium due to high-speed air turbine drill used during a dental procedure. Ann Thorac Surg 2014; 98:2232. [PMID: 25468103 DOI: 10.1016/j.athoracsur.2014.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/01/2014] [Accepted: 08/08/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
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Kim YH, Cho SI, Do NY, Park JH. A case of pharyngeal injury in a patient with swallowed toothbrush: a case report. BMC Res Notes 2014; 7:788. [PMID: 25374403 PMCID: PMC4233075 DOI: 10.1186/1756-0500-7-788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/22/2014] [Indexed: 01/19/2023] Open
Abstract
Background Otolaryngologists encounter cases of various foreign bodies in the oral and pharyngeal regions. One commonly found foreign body is a fish bone, ingested in most cases by carelessness or an accident. These foreign materials are removed by endoscopy or through a simple procedure. However, hypopharyngeal damage is rarely caused by a foreign body in the pharynx following the swallowing of a toothbrush. Case presentation A 44-year-old Asian male visited the emergency room with chief complaints of intraoral pain and dysphagia that had started on the same day. The patient had paranoid-type schizophrenia that began 10 years ago; he had been hospitalized and was being treated at another clinic, and was transferred to the emergency room by the medical staff after swallowing a toothbrush. We successfully removed a toothbrush located within the pharynx of a patient with a history of a psychologic disorder via surgery and conservative treatment. Conclusion The case with this patient, and a rapid diagnosis as well as treatment is imperative. The presence and state of a foreign body must be determined through a careful physical examination and imaging, followed by the immediate removal of the foreign body, all while keeping in mind the possibility of accompanying damage to nearby tissues.
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Affiliation(s)
| | | | | | - Jun-Hee Park
- Department of Otolaryngology-Head and Neck surgery, Chosun University, 365 Pilmun-daero, Dong-gu, Gwanju 501-717, South Korea.
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Sieswerda-Hoogendoorn T, Strik AS, Hilgersom NFJ, Soerdjbalie-Maikoe V, van Rijn RR. Pneumomediastinum and soft tissue emphysema in pediatric hanging. J Forensic Sci 2013; 59:559-63. [PMID: 24328897 DOI: 10.1111/1556-4029.12315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 11/30/2012] [Accepted: 12/16/2012] [Indexed: 11/29/2022]
Abstract
Postmortem computed tomography (CT) is increasingly being used as a tool in forensic pathology. The exact value of postmortem imaging in detecting specific conditions has not yet been established, but in specific cases, it can be used as a diagnostic tool demonstrating findings that remain undetected during autopsy, as in this case. Pneumomediastinum and soft tissue emphysema were detected with postmortem CT in a 3-year-old girl after hanging. It was not found during autopsy. This radiological finding matches 3 adult cases previously described. It is assumed that in this case, the first reported in a child, hanging was the most likely cause as well. In the adult cases, it was interpreted as a vital sign; the person must have been alive to create a pressure gradient causing rupture of the alveoli. This case demonstrates one of the added values of postmortem imaging, the possibility of demonstrating findings that remain undetected during autopsy.
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Affiliation(s)
- Tessa Sieswerda-Hoogendoorn
- Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044 2490 AA the Hague, The Netherlands; Department of Radiology, Emma Children's Hospital, Academic Medical Centre (AMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Kim T, Kim JY, Woo YC, Park SG, Baek CW, Kang H. Pneumomediastinum and pneumothorax after orthognathic surgery -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S242-5. [PMID: 21286451 PMCID: PMC3030047 DOI: 10.4097/kjae.2010.59.s.s242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 03/25/2010] [Accepted: 04/02/2010] [Indexed: 11/24/2022] Open
Abstract
The occurrences of pneumomediastinum and pneumothorax after oral and/or maxillofacial surgery are rare, but both are potentially life-threatening complications. Most of the cases that present pneumomediastinum and pneumothorax in the oral and/or maxillofacial surgery result from air dissecting down the fascial planes of the neck. We report a case of a 23-year-old male patient who underwent bilateral sagittal split ramus osteotomy under general anesthesia and developed pneumomediastinum and pneumothorax without any traumatic introduction of air through the cervical fascia three days postoperatively. The possible causes and its prevention are discussed with a review of the relevant literature.
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Affiliation(s)
- Taehwa Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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Porteri E, Rizzardi N, Rizzoni D, Salvi A, De Ciuceis C, Farina D, Boari GEM, Platto C, Paiardi S, Raed A, Rosei EA. A strange chest pain after dental surgery. Intern Emerg Med 2008; 3:123-6. [PMID: 18437292 DOI: 10.1007/s11739-008-0143-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 02/28/2008] [Indexed: 12/01/2022]
Affiliation(s)
- Enzo Porteri
- Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Brescia, Italy
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Bars N, Atlay Y, Tülay E, Tanju G. Extensive subcutaneous emphysema and pneumomediastinum associated with blowout fracture of the medial orbital wall. ACTA ACUST UNITED AC 2007; 64:1366-9. [PMID: 17514044 DOI: 10.1097/01.ta.0000235507.60878.3d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Naiboğlu Bars
- Department of Otolaryngology-Head and Neck Surgery, Haydarpaoa Numune Training and Research Hospital, Istanbul, Turkey.
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Shine NP, Sader C, Coates H. Cervicofacial emphysema and pneumomediastinum following pediatric adenotonsillectomy: a rare complication. Int J Pediatr Otorhinolaryngol 2005; 69:1579-82. [PMID: 15939486 DOI: 10.1016/j.ijporl.2005.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 04/18/2005] [Indexed: 12/16/2022]
Abstract
Cervicofacial emphysema and pneumomediastinum are rarely observed sequelae of surgical intervention in the upper aerodigestive tract. It is a potentially life-threatening condition but the majority of cases are self-limiting and benign. Symptoms include chest pain, neck pain, dyspnea and odynophagia. A case occurring after adenotonsillar surgery in a 7-year-old child is presented. This report highlights this unusual complication and its potential to delay the postoperative recovery following adenotonsillectomy.
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Affiliation(s)
- Neville Patrick Shine
- Department of Pediatric Otolaryngology, Princess Margaret Hospital, Roberts Road, 20 Jarrad Street, Subiaco, Cottesloe, WA 6011, Australia.
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Mastrovich JD, Peters N, Tripathi A. Acute onset of facial swelling during colonoscopy in a 50-year-old woman. Ann Allergy Asthma Immunol 2004; 92:307-12. [PMID: 15049393 DOI: 10.1016/s1081-1206(10)61567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John D Mastrovich
- Division of Allergy-Immunology, Department of Medicine, and the Ernest S. Bazley Asthma and Allergic Diseases Center of Northwestern Memorial Hospital and Northwestern University Medical School, Chicago, Illinois 60611, USA
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Ali A, Cunliffe DR, Watt-Smith SR. Surgical emphysema and pneumomediastinum complicating dental extraction. Br Dent J 2000; 188:589-90. [PMID: 10893812 DOI: 10.1038/sj.bdj.4800547] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Subcutaneous and mediastinal emphysema is a rare complication of dental extraction and the use of air turbines has often been implicated. We describe a case which highlights a serious complication of the use of an air rotor for the removal of a right second mandibular molar.
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Affiliation(s)
- A Ali
- Oral and Maxillofacial Surgery Unit, John Radcliffe Hospital, Oxford
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Abstract
Subcutaneous emphysema occurs when air is introduced into the tissues. This can happen as a complication during, or immediately after surgery. It has rarely been described after tonsillectomy. Definitive treatment will depend on the cause. We report two cases of subcutaneous emphysema following tonsillectomy.
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Affiliation(s)
- S M Hampton
- Department of Otolaryngology, Belfast City Hospital Trust, Northern Ireland
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Abstract
Pneumothorax during pregnancy is rare. A case report is presented and a novel way of managing the problem is discussed.
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Affiliation(s)
- A J Levine
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, UK
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Torres-Melero J, Arias-Diaz J, Balibrea JL. Pneumomediastinum secondary to use of a high speed air turbine drill during a dental extraction. Thorax 1996; 51:339-40; discussion 340-1. [PMID: 8779147 PMCID: PMC1090655 DOI: 10.1136/thx.51.3.339] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pneumomediastinum and subcutaneous emphysema of the neck and thorax can occur exceptionally following a dental procedure. A case is described of acute subcutaneous emphysema of the lateral region of the neck and thorax associated with pneumomediastinum during a dental extraction with an air and water cooled turbine burn drill.
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Affiliation(s)
- J Torres-Melero
- Department of Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain
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Battrum DE, Gutmann JL. Implications, prevention and management of subcutaneous emphysema during endodontic treatment. ENDODONTICS & DENTAL TRAUMATOLOGY 1995; 11:109-14. [PMID: 7641625 DOI: 10.1111/j.1600-9657.1995.tb00470.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Subcutaneous emphysema (SCE) is a possible complication of both nonsurgical and surgical endodontic treatment. A review of the literature pertinent to endodontic intervention and SCE is highlighted, while the causes of and recommendations for the prevention of SCE are provided. A review of the pathways whereby compressed air may travel through potential spaces in the head and neck is also illustrated in an attempt to identify the possibility of morbidity and even mortality should operator induced SCE occur in a patient.
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Affiliation(s)
- D E Battrum
- Department of Restorative Sciences, Baylor College of Dentistry, Dallas, Texas 75246, USA
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Oliver AJ, Diaz EM, Helfrick JF. Air emphysema secondary to mandibular fracture: case report. J Oral Maxillofac Surg 1993; 51:1143-5. [PMID: 8410453 DOI: 10.1016/s0278-2391(10)80455-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- A J Oliver
- Department of Oral and Maxillofacial Surgery, University of Texas Health Sciences Center at Houston 77225
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