Cervicofacial subcutaneous emphysema: case report and review of literature

A Case Report on Cervicofacial Subcutaneous Emphysema and Its Management: A Unique Presentation of Congenital Defect of the Foramen of Huschke

Congenital defect to the foramen of Huschke with a manifestation as temporomandibular joint (TMJ) soft tissue herniation in a radiological study is rare. The patient may present with nonspecific symptoms such as otalgia, mandibular joint pain, tinnitus and conductive hearing loss, and scarcely cervicofacial subcutaneous emphysema. Here, we report a patient presented with cervicofacial subcutaneous emphysema secondary to a congenital defect of the foramen of Huschke. A 45-year-old gentleman presented with right-sided neck swelling and right otalgia with a crackling sound over the right ear upon chewing. Examination shows right-sided fullness with subcutaneous emphysema from the zygoma to the upper neck. Otherwise, it is non-tender with no skin changes, and the facial nerve is intact. Otoendoscopy shows erythematous soft tissue bulging of the anterior wall of the right external auditory canal (EAC) upon closing the mouth and prolapsing upon mouth opening. The right tympanic membrane was intact. Contrast-enhanced computer tomography (CECT) of the neck and temporal region revealed extensive cervicofacial subcutaneous emphysema with a bony defect at the anterior wall of the right EAC, indicating fistulous communication between the right EAC and TMJ. The subcutaneous emphysema resolved on the treatment of the right otitis externa. The patient is subjected to a combined approach of open and endoscopic-assisted repair of the anterior EAC wall defect. TMJ herniation into the anterior EAC is rare; however, the patient presentation may vary. CECT is the gold standard for diagnosing and facilitating treatment options. Treatment choice is based on the patient's condition, including conservative or surgical intervention.

Pronounced mediastinal emphysema after restorative treatment of the lower left molar-a case report and a systematic review of the literature

This case report presents an iatrogenic induced mediastinal emphysema after restorative treatment of the lower left second molar, aimed to highlight the potential life-threatening consequences, and providing diagnostics and treatment concepts of complicated dental induced emphysema based on literature review. A 74-year-old female patient was admitted to the emergency department due to a fall on her shoulder. Additional finding was a significant swelling of the face and neck. In the computer tomography of the head, neck, and thorax, a humerus fracture and pronounced soft tissue emphysema from the infraorbital region to the mediastinum was detected. The patient reported that she had been treated by her dentist 4 days earlier. The treatment had to be discontinued after beginning of a pronounced swelling. Other reasons for the emphysema could be excluded out on an interdisciplinary teamwork. The patient was monitored as an inpatient for 5 days and received intravenous antibiotic therapy. This case report shows the rare complication of pronounced mediastinal emphysema after root canal treatment. Emphysema should always be a differential diagnosis of soft tissue swelling and, in case of doubt, a general medical presentation should be made.

Orbital emphysema as a result of chest tube placement for recurrent pneumothorax

Orbital emphysema refers to the presence of air or gas within the orbital soft tissue space. Although orbital fracture due to trauma is the most common cause, iatrogenic orbital emphysema from chest tube insertion is a rare but potentially serious complication from the treatment of pneumothorax. Symptoms can range from mild crepitus of the periorbital region to permanent vision loss secondary to central retinal artery occlusion or optic neuropathy, a result of orbital compartment syndrome. Management is dependent on the presence of orbital signs and vision loss. Herein, we present a rare case of orbital emphysema in the setting of pneumothorax and chest tube insertion in a 62 year-old patient admitted to the hospital floor. Presenting symptoms included vision loss and bilateral orbital edema, while physical exam revealed complete ptosis of the right eye with diffuse periorbital emphysema and crepitus. Diagnosis was confirmed clinically and with CT head and orbits. The patient's vision loss was felt to be secondary to ptosis; thus, interventions were not necessary and his condition resolved with observation. The present case and associated literature review highlights orbital emphysema as a complication of chest tube insertion and pneumothorax, as well as the drastic complications of the condition if left untreated.

Subcutaneous Emphysema Related to Dental Treatment: A Case Series

Cervicofacial subcutaneous emphysema (SE) is primarily caused by dental treatment introducing gas into the subcutaneous tissue. Air rapidly dissects into the subcutaneous tissue with face and neck swelling, leading to respiratory distress, patient discomfort, and chest pain. Computed tomography (CT) can detect spreading SE patterns. However, the true volume of SE and the degree of air changes in the body over time remain unknown. We evaluated the healing process of SE and the temporal changes in the volume of emphysema in three cases detected using our hospital’s electronic health record systems based on inclusion and exclusion criteria over the past 10 years, with CT and three-dimensional (3D) images. The first case was a 46-year-old woman who presented with complaints of swelling from her right eyelid to the neck and clavicles, pain on swallowing, respiratory distress, and hoarseness. The second case was a 35-year-old man who presented with complaints of swelling over the face. The third case was a 36-year-old man who presented with complaints of swelling from the left cheek to the neck. CT revealed SE and pneumomediastinum in all cases. All the patients were administered an antibacterial drug. The CT and 3D images showed an improvement in emphysema 3 days after the onset, with more than half of the volume reduction in emphysema. This made it possible to evaluate the changes in the air content of SE. Observation with CT until the healing process of SE is completed is crucial, and 3D images also help evaluate changes over time.

Subcutaneous Facial Emphysema Following Open-Flap Air-Powder Abrasive Debridement for Peri-Implantitis: A Case Report and an Overview

Subcutaneous facial emphysema related to dental treatments is a well-known clinical complication due to incidental or iatrogenic air or gas penetration into the subcutaneous tissues and fascial planes, leading to distension of the overlying skin. To the best of our knowledge, from 1960 to the current date, only six cases have been reported arising from peri-implant cleaning or non-surgical peri-implantitis treatment. Therefore, the present case of subcutaneous facial emphysema following open-flap air-powder abrasive debridement was the first report during surgical peri-implantitis therapy. Swelling on the left cheek and periorbital space suddenly arose in a 65-year-old woman during open-flap debridement with sodium bicarbonate air-powder abrasion (PROPHYflex™ 3 with periotip, KaVo, Biberach, Germany) of the infected implant surface. The etiology, clinical manifestations, diagnosis, potential complications, and management of subcutaneous emphysema are also briefly reviewed. The present case report draws the attention of dental practitioners, periodontists, oral surgeons, and dental hygienists to the potential iatrogenic risk of subcutaneous emphysema in using air-powder devices in implant surface debridement.

Facial Emphysema following Closure of Oroantral Fistulae

Subcutaneous emphysema (SE) is a swelling which develops due to air entrapped underneath the subcutaneous tissue and facial planes causing distention of the overlying skin. SE can develop due to trauma, surgery, or infection. The diagnosis of SE is mostly based on clinical findings of crepitation upon palpation of the swelling. Once diagnosed, SE is usually managed by close observation and in some cases may require surgical decompression and antibiotic prophylaxis. We report a rare case of SE of the left malar which developed following closure of oroantral communication using the buccal fat pad.

Case Report: Subcutaneous Emphysema and Pneumomediastinum Following Dental Extraction

Introduction

Emergency physicians should be cognizant of complications following common procedures (including dental) and be able to readily care for patients with acute dental pain.

Case Report

A 22-year-old female presented with dental pain and difficulty swallowing that developed 48 hours after she underwent a dental extraction. The physical exam showed an uncomfortable, afebrile female with dysphonia, inability to tolerate secretions, and crepitus over the neck and anterior chest wall.

Discussion

The use of a high-speed dental drill may have caused air to dissect through fascial planes leading to subcutaneous emphysema, or even through deeper planes resulting in pneumomediastinum. It should be noted that subcutaneous emphysema and pneumomediastinum are rare complications of dental procedures.

Conclusion

This case highlights an uncommon but potentially life-threatening complication following a routine dental procedure, which emergency clinicians should be attentive to and able to identify and thereby manage.

Cervicofacial Emphysema Complicating a Dental Procedure

BACKGROUND

Cervicofacial subcutaneous emphysema can occur rarely after a dental procedure, especially tooth extraction, and can be misdiagnosed as an allergic reaction or post-procedure swelling.

CASE REPORT

We report a rare case of a 29-year-old man who developed extensive cervicofacial subcutaneous emphysema after a dental hygiene procedure. A review of the relevant literature is presented in our report. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early identification and management of this potentially life-threatening condition is particularly important and can prevent serious complications, leading to improved patient outcomes.

Pulmonary aspergilloma with subcutaneous fistula resulting in massive hemoptysis & subcutaneous emphysema

Aspergillomas growing in pre-existing lung cavities can lead to presentations of hemoptysis. We present a case of a 73-year-old male with non-small cell lung carcinoma (NSCLC) and known 4 cm left cavitary lesion in the left upper lobe presenting with cough and hemoptysis, leading to the diagnosis of a pulmonary aspergilloma complicated by chest wall subcutaneous emphysema due to cavitary-subcutaneous fistula in the setting of excessive cough. This case sheds light on subcutaneous emphysema as a potential rare complication of aspergillomas in patients without prior trauma.

Management of subcutaneous facial emphysema secondary to a class V dental restoration

Subcutaneous facial emphysema (SFE) is a potentially serious complication of dental treatment typically associated with surgical removal of teeth using air-driven handpieces. A case of SFE is presented occurring after routine dental restoration, along with a framework to aid prevention of this complication and guide management where it occurs.

Subcutaneous emphysema related to dental procedures

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.

Emphysema following air-powder abrasive treatment for peri-implantitis

Background

Subcutaneous emphysema refers to swelling caused by the presence of air or gas in the interstices of loose connective tissue. In the head and neck area, it may follow the fascial planes and is characterized by sudden swelling, crepitus on palpation, infrequent pain, and air emboli on radiography. It usually occurs as a complication in dental treatment. Some reports have described subcutaneous emphysema caused by dental procedures; however, severe emphysema related to peri-implantitis after treatment has not been documented. Accordingly, the current report describes a rare case of subcutaneous cervical emphysema resulting from the use of an air-powder abrasive device to treat peri-implantitis.

Case presentation

Based on a review of the existing literature and the present case, nine cases of subcutaneous emphysema due to air-powder abrasive device have been reported. In most cases, the emphysema resolved over time after treatment with prophylactic antibiotics; among these, two were related to peri-implantitis management.

Conclusion

Considering the frequent use of air-powder abrasive devices to treat peri-implantitis, the potential risk of iatrogenic emphysema related to this procedure needs to be addressed more extensively.

Don't Blow It! Extensive Subcutaneous Emphysema of the Neck Caused by Isolated Facial Injuries: A Case Report and Review of the Literature

BACKGROUND

Although subcutaneous emphysema resulting from maxillofacial surgery is well described in the literature, the association with maxillofacial trauma is less firm. Clinically evident subcutaneous emphysema from facial injury is uncommon and extension into the cervical and mediastinal tissues is exceedingly rare, with few reported cases.

CASE REPORT

An unusual case of extensive subcutaneous emphysema after facial trauma is presented. The case posed a diagnostic dilemma in our emergency department. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: Facial fractures are a rare but important cause of surgical emphysema. Emergency physicians need to be aware of the diagnostic possibility and the need to avoid factors that may precipitate secondary injury.

Orbital and Periorbital Emphysema Following Maxillary Sinus Floor Elevation: A Case Report and Literature Review

During the past 150 years, subcutaneous emphysema has been described as a rare complication in dentistry, the etiology of which might be maneuvers performed by the patient (eg, sneezing while the mouth is closed, blowing the nose) or the dental professional through the use of specific dental instruments (eg, dental drill, air syringe, etc). Irrespective of etiology, air is forced through the soft tissues, thus producing rapid swelling of the area. According to the most recent literature reviews, the iatrogenic etiology is the most frequent. This report describes the first case of emphysema related to the orbital and periorbital region after a maxillary sinus floor elevation procedure.

Blunt maxillary fracture and cheek bite: two rare causes of traumatic pneumomediastinum

Subcutaneous facial emphysema is a well-known consequence of oral and maxillofacial traumatic injury. In some rare cases, the subcutaneous air collection could spread through the retropharyngeal and paralatero-cervical spaces, reaching the mediastinum. This clinical entity is known as pneumomediastinum and represents a severe and, sometimes, life-threatening condition. Other reported causes of pneumomediastinum are esophageal and tracheal traumatic or iatrogenic rupture. Finally, the so-called spontaneous pneumomediastinum is caused by a sudden increase in alveolar pressure and is usually seen in young men. We present two cases of pneumomediastinum as a consequence of unusual traumatic damage of orofacial tissues, followed by repeated sneezing and Valsalva maneuver.

[Visit at the dentist with consequences]

A 52-year-old patient presented to the emergency department of the polyclinic with a cervicofacial swelling. The indolent swelling appeared after professional tooth cleaning. Computed tomography scanning of the cervical region and thorax revealed entrapped air extending from the frontotemporal to the mediastinal regions. The patient was diagnosed with cervicofacio mediastinal emphysema and subsequently treated with antibiotics. The symptoms subsided and the patient left hospital free of symptoms.

Subcutaneous emphysema

Subcutaneous emphysema is a potential surgical complication arising due to introduction of air into the facial planes of the connective tissue. presence of air and accompanying inflammation and or infection could prove fatal in immediate post surgical scenario. This case report aims to prevent one such case of subcutaneous emphysema that was promptly diagnosis and effectively managed.

Perforation of the piriform sinus after sneezing with cervical subcutaneous emphysema and pneumomediastinum

INTRODUCTION

Cervical subcutaneous emphysema and pneumomediastinum are often secondary to trauma, surgery or infection. More rarely, they can be spontaneous with no identified cause, but forced Valsalva manoeuvres are a known predisposing factor. Any forced effort with a closed glottis, such as sneezing, can cause rupture of the mucosa leading to the formation of cervical subcutaneous emphysema and pneumomediastinum.

CASE REPORT

The authors report the case of a 30-year-old man with cervical subcutaneous emphysema complicated by pneumomediastinum due to fistula of the piriform sinus following sneezing while simultaneously obstructing both nostrils.

DISCUSSION/CONCLUSION

Rupture of the mucosa of the piriform sinus is an extremely rare complication of this type of manoeuvre. This condition requires management in hospital due to the risk of infection with cervical cellulitis progressing to mediastinitis. Simultaneously obstructing both nostrils during sneezing is a dangerous manoeuvre that should be avoided.