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AlEnazi AS, AlMuhanna ZJA, Alfaraj AS, Abduljabbar A AlKhawaja H, AlTamimi SK, Alsaied AS, Ashoor MM. Retropharyngeal Emphysema Following Local Palate Trauma. Cureus 2022; 14:e32029. [PMCID: PMC9708345 DOI: 10.7759/cureus.32029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
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2
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Papadiochos I(Y, Sarivalasis SE, Chen M, Goutzanis L, Kalyvas A. Pneumomediastinum as a Complication of Oral and Maxillofacial Injuries: Report of 3 Cases and a 50-Year Systematic Review of Case Reports. Craniomaxillofac Trauma Reconstr 2022; 15:72-82. [PMID: 35265281 PMCID: PMC8899344 DOI: 10.1177/1943387521997236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives Pneumomediastinum (PM) secondary to oromaxillofacial trauma (OMF) is a rare but well-described complication/pathologic finding. The aim of this study was twofold: first, to report our experience in treatment of maxillofacial trauma patients with PM, and second, to review the literature regarding the clinical features, severity, course, and management of the aforementioned complication. Material and methods We retrospectively reviewed the medical records and charts of patients who suffered from maxillofacial trauma and treated in our hospital between September 1, 2013 and September 31, 2017. The inclusion criteria were patients with radiologically confirmed PM. In addition, the electronic databases PubMed, Scopus, and Science Direct were queried for articles reporting PM cases secondary to OMF injuries and published in English, French, and German language. Results Three cases of PM out of 3,514 cases of craniomaxillofacial trauma were found; there were 3 male patients who presented in our emergency department with the chief complaint of cervicofacial swelling. Literature search isolated 58 selected articles and 63 cases were assessed in total; posttraumatic repeated blowing of nose was proved as most frequent triggering factor among them. Furthermore, the outcomes of review showed that thoracic pain, respiratory distress, and swallowing difficulties were not frequently reported in patients with ME due to facial trauma. Conclusions Both our experience and the results of systematic literature review indicated that patients with PM due to OMF injuries present mild clinical course. If properly managed, this specific pathologic condition may have no further complications or relative comorbidities. The exact etiology and mechanism of PM in the context of maxillofacial injuries always needs to be identified. Radiographic, laboratory, and endoscopic examinations should be applied to rule out the more serious and frequently diagnosed aerodigestive, thoracic, and abdominal causes of PM.
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Affiliation(s)
- Ioannis (Yiannis) Papadiochos
- «Attikon» University General Hospital of Athens, Haidari, Greece,Evaggelismos General Hospital of Athens, Athens, Greece,Ioannis (Yiannis) Papadiochos, MD, DDS, OMFS, «Attikon» University General Hospital of Athens, Haidari, Greece; University Clinic of Maxillofacial and Oral Surgery, Medical of School of Athens, Athens, 124 62, Greece.
| | - Stavros-Evangelos Sarivalasis
- Evaggelismos General Hospital of Athens, Athens, Greece,Department of Plastic Surgery, Hygeia Hospital, Athens, Greece
| | - Meg Chen
- Department of Oral & Maxillofacial Surgery, 63461National Cheng Kung University Hospital, Tainan
| | - Lampros Goutzanis
- Evaggelismos General Hospital of Athens, Athens, Greece,Dental School of Athens, Evaggelismos General Hospital of Athens, Athens, Greece
| | - Aristotelis Kalyvas
- Evaggelismos General Hospital of Athens, Athens, Greece,Neuro-Oncology and Skull Base Surgery, University of Toronto, Toronto, ON, USA
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3
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Jeong CH, Yoon S, Chung SW, Kim JY, Park KH, Huh JK. Subcutaneous emphysema related to dental procedures. J Korean Assoc Oral Maxillofac Surg 2018; 44:212-219. [PMID: 30402412 PMCID: PMC6209696 DOI: 10.5125/jkaoms.2018.44.5.212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023] Open
Abstract
Objectives The objective of this study was to analyze 11 cases of subcutaneous emphysema associated with dental procedures from a single hospital and discuss approaches for accurate diagnosis and treatment of the condition. Materials and Methods The medical records of 11 patients who were treated for subcutaneous emphysema related to dental procedures between January 2009 and April 2017 were analyzed retrospectively. Patients with subcutaneous emphysema within the facial area or that spread to the neck and beyond, including the facial region, were assigned to two groups and compared in terms of age, sex, and durations of antibiotic use, hospitalization, and follow-up until improvement. The correlation between location of the origin tooth and range of emphysema spread was analyzed. Results The average durations of antibiotic use during conservative treatment and follow-up until improvement were 8.55 days (standard deviation [SD], 4.46 days) and 1.82 weeks (SD, 1.19 weeks), respectively. There was no intergroup difference in duration of antibiotic use (P=0.329) or follow-up (P=0.931). Subcutaneous emphysema was more common after dental procedures involving the maxilla or posterior region than after those involving the mandible or anterior region. There was no significant difference in air distribution according to location of the air orifice (maxilla, mandible, or both; P=0.106). Conclusion Upon adequate conservative treatment accompanied by prophylactic antibiotic treatment considering the risk of infection, patients showed signs of improvement within a few days or weeks. There was no significant difference in treatment period between patients with subcutaneous emphysema localized to the facial region and those with subcutaneous emphysema spreading to the neck or beyond. These findings need to be confirmed by analysis of additional cases.
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Affiliation(s)
- Cheol-Hee Jeong
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Seungkyu Yoon
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Seung-Won Chung
- Department of Dentistry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Kwang-Ho Park
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
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Charles-de-Sá L, Faria D, Benedetti B, de Castro CC, Aboudib JH. Periorbital subcutaneous emphysema in rhinoplasty. Aesthet Surg J 2014; 34:516-9. [PMID: 24609943 DOI: 10.1177/1090820x14526616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this article, the authors present a case of postrhinoplasty periorbital subcutaneous emphysema in a 35-year-old woman. This is an uncommon and benign rhinoplasty complication that can sometimes result from other pathologies such as barotrauma, hematoma, and allergic reaction. This patient's symptoms appeared to be a result of postanesthesia agitation. The patient's symptoms resolved after 1 week.
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Affiliation(s)
- Luiz Charles-de-Sá
- Department of Plastic, Reconstructive and Aesthetic Surgery, Training and Research State University Hospital, Rio de Janeiro-UERJ, Brazil
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Santos SE, Sawazaki R, Asprino L, de Moraes M, Fernandes Moreira RW. A rare case of mediastinal and cervical emphysema secondary mandibular angle fracture: a case report. J Oral Maxillofac Surg 2011; 69:2626-30. [PMID: 21683498 DOI: 10.1016/j.joms.2011.02.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Revised: 02/16/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Saulo Ellery Santos
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil.
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6
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Roccia F, Diaspro A, Pecorari GC, Bosco G. Pneumomediastinum and cervical emphysema associated with mandibular fracture. THE JOURNAL OF TRAUMA 2007; 63:924-6. [PMID: 17308496 DOI: 10.1097/01.ta.0000222553.43557.ea] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Fabio Roccia
- Divisions of Maxillofacial Surgery, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
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7
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Ong WC, Lim TC, Lim J, Sundar G. Cervicofacial, retropharyngeal and mediastinal emphysema: a complication of orbital fracture. Asian J Surg 2005; 28:305-8. [PMID: 16234086 DOI: 10.1016/s1015-9584(09)60367-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Retropharyngeal and mediastinal emphysema is associated with traumatic aerodigestive tract injury, and may be associated with potentially severe and even life-threatening complications. Retropharyngeal emphysema or pneumomediastinum, in the absence of severe trauma to the visceral organs, is rare following facial fractures. We report a case of extensive subcutaneous emphysema extending to the retropharyngeal space and mediastinum following an orbitozygomatic fracture.
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Affiliation(s)
- Wei Chen Ong
- Division of Plastic Surgery, Department of Surgery, National University Hospital, Singapore
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Monksfield P, Whiteside O, Jaffé S, Steventon N, Milford C. Pneumomediastinum, an Unusual Complication of Facial Trauma. EAR, NOSE & THROAT JOURNAL 2005. [DOI: 10.1177/014556130508400515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumomediastinum is often an incidental finding following a blunt or penetrating trauma to the neck or chest. We report a rare case of pneumomediastinum following an isolated facial trauma that was diagnosed on imaging. We also review the clinical signs of this condition, its radiologic characteristics, and the 18 previously reported cases of pneumomediastinum following facial trauma.
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Affiliation(s)
| | | | - Susan Jaffé
- Department of Radiology, John Radcliffe Hospital, Oxford, U.K
| | - Nick Steventon
- Department of Otolaryngology, Radcliffe Infirmary, Oxford, U.K
| | - Chris Milford
- Department of Otolaryngology, Radcliffe Infirmary, Oxford, U.K
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Roccia F, Griffa A, Nasi A, Baragiotta N. Severe subcutaneous emphysema and pneumomediastinum associated with minor maxillofacial trauma. J Craniofac Surg 2004; 14:880-3. [PMID: 14600631 DOI: 10.1097/00001665-200311000-00011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In the maxillofacial region, subcutaneous emphysema, which occurs after fractures of the pneumatic paranasal sinuses, is a common finding in a maxillofacial surgeon's daily practice. Pneumomediastinum secondary to these fractures is a less frequent event, however, without thoracic or abdominal injuries. The authors report a case of severe subcutaneous emphysema and pneumomediastinum that occurred after fractures of the nasal bones and medial orbital wall. The etiology, diagnosis, and treatment modalities of mediastinal emphysema are discussed.
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Affiliation(s)
- Fabio Roccia
- Division of Maxillofacial Surgery, S. Giovanni Battista Hospital, University of Torino, Torino, Italy.
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10
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Ortak T, Mithat Akan I, Sensöz O. Subcutaneous emphysema of the eyelid and orbital cone after maxillary fracture. Ann Plast Surg 2001; 46:195. [PMID: 11216627 DOI: 10.1097/00000637-200102000-00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Celebioğlu S, Keser A, Ortak T. An unusual complication of rhinoplasty: subcutaneous emphysema. BRITISH JOURNAL OF PLASTIC SURGERY 1998; 51:266-7. [PMID: 9664896 DOI: 10.1016/s0007-1226(98)80027-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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12
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Abstract
A case of subcutaneous emphysema and pneumomediastinum as a result of child abuse is presented to add to the spectrum of findings associated with child maltreatment. This case is a reminder that although most cases of subcutaneous emphysema resolve uneventfully, there still needs to be an aggressive search for a cause. In addition, in the pediatric age group, the history given should be carefully verified as being plausible because of the possibility that child abuse may be the true etiology.
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Affiliation(s)
- B C Bansal
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA
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13
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Rudloff E, Crowe DT, Kirby R, Mammato B. Suspected Tension Pneumomediastinum In A Dog: A Case Report. J Vet Emerg Crit Care (San Antonio) 1996. [DOI: 10.1111/j.1476-4431.1996.tb00038.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Reiche-Fischel O, Helfrick JF. Intraoperative life-threatening emphysema associated with endotracheal intubation and air insufflation devices: report of two cases. J Oral Maxillofac Surg 1995; 53:1103-7. [PMID: 7643284 DOI: 10.1016/0278-2391(95)90133-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Two cases of life-threatening body emphysema with decompensating pneumothoraces, pneumomediastinum, and pneumopericardium intraoperatively have been presented. The most likely cause was tracheal perforation combined with high pressure ventilation. Although subcutaneous emphysema and pneumomediastinum are self-limiting conditions with rapid recovery with conservative treatment, life-threatening complications may arise requiring prompt recognition and specific surgical management in order to save the patient's life.
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Affiliation(s)
- O Reiche-Fischel
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, USA
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15
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Sansevere JJ, Badwal RS, Najjar TA. Cervical and mediastinal emphysema secondary to mandible fracture: case report and review of the literature. Int J Oral Maxillofac Surg 1993; 22:278-81. [PMID: 8245566 DOI: 10.1016/s0901-5027(05)80515-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cervical and mediastinal emphysema is a rare but serious, life-threatening complication associated with mandibular fractures secondary to high-impact trauma. A case is reported in which a 24-year-old white man involved in a motor vehicle accident presented with an isolated mandibular fracture, cervical emphysema, and pneumomediastinum. A review of the literature is presented, and relevant anatomy and management are discussed.
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Affiliation(s)
- J J Sansevere
- Department of Oral and Maxillofacial Surgery, University Hospital, Newark, NJ
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16
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Shackelford D, Casani JA. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumothorax after dental extraction. Ann Emerg Med 1993; 22:248-50. [PMID: 8427441 DOI: 10.1016/s0196-0644(05)80214-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Subcutaneous emphysema, pneumomediastinum, and pneumothorax may result from surgical procedures and trauma and usually do not present a diagnostic dilemma. We present a case of subcutaneous emphysema, pneumomediastinum, pneumothorax, and pneumoretroperitoneum after a dental procedure with an air-and-water-cooled turbine burr drill. This allowed air and water under pressure to be driven into the field and track through the fascial planes. Although this is a common occurrence, these patients frequently go undiagnosed or misdiagnosed as allergic reactions to locally administered anesthetic agents. If a large amount of air is injected, it may track into not only the subcutaneous tissues but also the mediastinum, pleural space, and retroperitoneal space. Patients with significant amounts of air must be admitted, observed for airway compromise, and be provided IV antibiotics and hydration.
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Affiliation(s)
- D Shackelford
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Anderson JA, Tucker MR, Foley WL, Pillsbury HC, Norfleet EA. Subcutaneous emphysema producing airway compromise after anesthesia for reduction of a mandibular fracture. A case report and review of the literature. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 71:275-9. [PMID: 2011348 DOI: 10.1016/0030-4220(91)90298-q] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Subcutaneous emphysema can occur as the result of trauma, surgery, and anesthesia. A case is presented of extensive subcutaneous emphysema after anesthesia for oral surgical reduction of a mandibular fracture. A discussion of the diagnosis, pathophysiology, and treatment of subcutaneous emphysema follows.
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Affiliation(s)
- J A Anderson
- University of North Carolina, School of Dentistry, Department of Oral & Maxillofacial Surgery, Chapel Hill 27599
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18
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Henry CH, Hills EC. Traumatic emphysema of the head, neck, and mediastinum associated with maxillofacial trauma: case report and review. J Oral Maxillofac Surg 1989; 47:876-82. [PMID: 2664108 DOI: 10.1016/s0278-2391(89)80053-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- C H Henry
- Medical Center of Delaware, Wilmington
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