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Tran V, Mian M, Sreedharan S, Robertson R, Saha A, Tadakamadla SK, Lee K. Oral and Maxillofacial Injuries Associated With E-Cigarette Explosions: A Systematic Review and Management Guidelines Proposal. J Oral Maxillofac Surg 2023; 81:583-592. [PMID: 36806607 DOI: 10.1016/j.joms.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE E-cigarettes have become increasingly popular devices used to consume nicotine in recent years. There is a growing body of evidence regarding the risk of spontaneous explosion of these devices causing burn and projectile injuries. The primary purpose of this review was to summarize all injuries to the oral and maxillofacial region secondary to explosion of e-cigarettes. The secondary purpose was to propose an initial management algorithm for such injuries based on the findings in the literature. This review also aims to test the hypothesis that e-cigarette explosive injuries to the oral region were associated with an increased risk of intubation and surgery and examine whether any other injury pattern was associated with an increased risk of intubation or surgery. METHODS A cohort study based on identifying cases in the literature was conducted to summarize injuries to the oral and maxillofacial region and examine the associations between injury types and location and management. A literature search of the major biomedical databases was conducted in September 2022 using terms such as e-cigarette, explosion, blast, trauma, and burn, among others, which yielded 922 studies. Nonclinical studies, review articles, and studies without injuries to the facial region were excluded. Study subjects were recorded for demographics, device characteristics, injury mechanism, injury location, management, and complications. Chi-squared analysis was used to determine if the predictor variables of type of injury (burn or projectile) and its associated location (ocular, facial, or intraoral for burns and facial thirds for projectile) were associated with the outcomes of intubation and surgical management. The collected data were then used as a guide to propose an initial management algorithm for these injuries. RESULTS Twenty eight studies, including 20 case reports and 8 case series met the inclusion criteria. A total of 32 explosions of e-cigarettes to 32 patients caused 105 recorded injuries to the facial region. Projectile injuries made up 73.3% (n = 77) of all facial injuries, while burn injuries made up of 26.7% (n = 28). There were 14 (43.8%) patients who suffered both projectile and burn injuries. Burn injuries mostly involved the face (64.3%, n = 18), oral cavity (25%, n = 7), and eye (10.7%, n = 7). The majority (81.8%, n = 63) of projectile injuries occurred in the lower facial third. There were 20 (62.5%) patients who suffered a bone or tooth fracture. Management of injuries involved surgery in 62.5% (n = 20) of patients, which included open reduction and internal fixation of fractures, dental extraction, bone and skin grafts, and ocular surgery. A complication rate of 44.4% (n = 8) was observed across studies that reported on follow-up. There was no statistically significant association between explosive injury to the oral region and intubation or surgical management. There was also no other statistically significant association between any other injury type and location with intubation or surgical management. CONCLUSIONS E-cigarettes are at risk for spontaneous combustion that can cause serious oral and maxillofacial injuries, particularly to the lower facial third and commonly requiring surgical management. Safety of these devices should be improved through increased user education and regulation.
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Affiliation(s)
- Vincent Tran
- Master of Philosophy Candidate, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
| | - Mustafa Mian
- Resident Medical Officer, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Subhashaan Sreedharan
- Resident Medical Officer, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ross Robertson
- Resident Medical Officer, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anik Saha
- Oral and Maxillofacial Registrar, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Santosh Kumar Tadakamadla
- Discipline Lead of Dentistry, Associate Professor, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Kai Lee
- Associate Professor, Consultant Oral & Maxillofacial Surgeon, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Dekhou A, Oska N, Partiali B, Johnson J, Chung MT, Folbe A. E-Cigarette Burns and Explosions: What are the Patterns of Oromaxillofacial Injury? J Oral Maxillofac Surg 2021; 79:1723-1730. [PMID: 33974919 DOI: 10.1016/j.joms.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE With the recent increase in popularity of electronic cigarette use in the United States, its harmful effects are not only limited to smoke inhalation, but also to the possibility of e-cigarette device malfunction. The purpose of this review is to characterize oromaxillofacial trauma secondary to electronic cigarette device explosion. METHODS For this systematic review, PubMed and Embase were searched in October 2019 using the following search terms: e-cigarette burns, e-cigarette injury, and e-cigarette explosions, which yielded 400 studies. Basic science research, animal studies, non-English studies, and reports of non-oromaxillofacial injuries were excluded. Study subject demographics, mechanism of trauma, injury type, treatment, and sequelae were recorded and analyzed. RESULTS Of all studies, 20 studies met inclusion criteria, including 14 case reports and 6 case series, with a total of 21 study subjects. For cases that reported sex, 100% were male (20) with a mean age of 29.5 years. Most common lacerations and/or burns involved the lips (10/21), tongue (8/21), soft palate and/or hard palate (4/21), and nose (5/21). Thirteen subjects underwent surgeries including oral-maxillofacial surgery or dental implants (7/13), bone graft repair (3/13), open reduction and internal fixation for preservation of sinus outflow tracts (2/13), foreign body removal from the cervical spine (1/13), and iridectomy (1/13). Reported complications included bone loss secondary to traumatic fracture, tinnitus and hearing loss, lip paralysis secondary to persistent edema, major depressive disorder/ post-traumatic stress disorder, persistent sinusitis, photophobia, and bilateral axillary and hand contractures. CONCLUSIONS Electronic cigarette device malfunction and explosion carries great risk for acute oromaxillofacial trauma that may be disfiguring. With the increasing popularity of electronic cigarette use, clinicians and patients should be advised regarding dangers of electronic cigarette use.
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Affiliation(s)
- Antonio Dekhou
- Oakland University William Beaumont School of Medicine, Rochester, MI.
| | | | - Benjamin Partiali
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Jared Johnson
- Wayne State University School of Medicine, Department of Otolaryngology, Detroit, MI
| | - Michael T Chung
- Wayne State University School of Medicine, Department of Otolaryngology, Detroit, MI
| | - Adam Folbe
- William Beaumont Hospital - Royal Oak, Department of Otolaryngology, Royal Oak, MI
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Injuries associated with electronic nicotine delivery systems: A systematic review. J Trauma Acute Care Surg 2020; 89:783-791. [PMID: 32590554 DOI: 10.1097/ta.0000000000002834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since its introduction on the market in 2007, the number of reports on injuries caused by the overheating, ignition, or explosion of electronic nicotine delivery systems (ENDSs) has increased significantly. These injuries appear to have different causes, the most important one being lithium-ion battery overheating to the point of ignition or explosion. METHODS A literature search for all relevant studies concerning ENDS-related traumatic injuries of all kinds was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol. The search started with the first introduction of ENDSs in 2007 and ended February 2020. Articles included were reports on patients who sustained flame, chemical, or traumatic injuries of the skin, soft tissue, and/or bone, related to the use of ENDSs. RESULTS This systematic review includes 180 patients from 41 case series and reports, published between 2016 and 2020. The mean age was 30.8 years (range, 17-59 years) with an overall male predominance (168 of 180 patients, 93%). In most injuries, multiple anatomical sites were affected, with the thigh/lower limb being the most commonly injured area (77%) followed by the upper limb/hand (43%). Eighty-two patients (51%) required a surgical treatment, 70 patients (43%) were managed conservatively with dressings or ointments, and 9 patients (6%) underwent enzymatic debridement. Thirty-five percent of all patients underwent skin grafting. CONCLUSION Injuries from overheating, ignition, or explosion of ENDSs are an emerging, underreported, and underresearched issue. There is a need for increased regulation of ENDSs and improved surveillance of related injuries. Both health care providers and consumers should be made aware of the risks and be advised about how to safely handle these devices. In contrast to other articles, this systematic review includes all types of injuries related to ENDS overheating, ignition, and explosion. To our knowledge, this is the most extensive systematic review performed to date. LEVEL OF EVIDENCE Review article, level III.
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Daniels M, Fuchs P, Oberländer H, Schiefer J, Seyhan H, Jan-Philipp S. [Where there´s smoke - there´s no fire? - Burns from E-Cigarette explosions]. HANDCHIR MIKROCHIR P 2020; 52:483-489. [PMID: 33291165 DOI: 10.1055/a-1237-4223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The popularity of E-Cigarettes is increasing. Besides addiction and pulmonary health damage, reports of burn injuries from e-cigarette explosions are also increasing. Mostly, explosions of e-cigarettes are attributed to its lithium-ion battery. Due to increasing cases and missing guidelines we want to present three cases of our hospital and publish recommendations for the management of burn injuries caused by e-cigarette explosions. PATIENTS/MATERIAL AND METHODS Three cases of e-cigarette explosions which occurred between 2016 and 2019, are presented. RESULTS All three e-cigarette explosions occurred in the trouser pockets. Two patients were male one patient was female. The age ranged from 24 to 64 years, the burned total body surface area (TBSA) from 3 % to 12.5 %. All three patients required skin grafting and the length of stay in hospital ranged from five to eleven days. CONCLUSION In the synopsis of recent literature, we recommend the following management of burns due to e-cigarette explosions. The guidelines of the Advanced Trauma Life Support should be followed, signs of an inhalation trauma should be checked and litmus test should be performed prior to irrigation with aqueous solutions to prevent exothermic reactions with remaining metals. If litmus test shows alkali pH wounds should be irrigated by mineral oil.
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Affiliation(s)
- Marc Daniels
- Kliniken der Stadt Köln gGmbH, Krankenhaus Köln Merheim, Abteilung für Plastische Chirurgie, Handchirurgie und Schwerbrandverletztenzentrum
| | - Paul Fuchs
- Kliniken der Stadt Köln gGmbH, Krankenhaus Köln Merheim, Abteilung für Plastische Chirurgie, Handchirurgie und Schwerbrandverletztenzentrum
| | - Henrik Oberländer
- Kliniken der Stadt Köln gGmbH, Krankenhaus Köln Merheim, Abteilung für Plastische Chirurgie, Handchirurgie und Schwerbrandverletztenzentrum
| | - Jennifer Schiefer
- Kliniken der Stadt Köln gGmbH, Krankenhaus Köln Merheim, Abteilung für Plastische Chirurgie, Handchirurgie und Schwerbrandverletztenzentrum
| | - Harun Seyhan
- Kliniken der Stadt Köln gGmbH, Krankenhaus Köln Merheim, Abteilung für Plastische Chirurgie, Handchirurgie und Schwerbrandverletztenzentrum
| | - Stromps Jan-Philipp
- Kliniken der Stadt Köln gGmbH, Krankenhaus Köln Merheim, Abteilung für Plastische Chirurgie, Handchirurgie und Schwerbrandverletztenzentrum
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Welter P, Ryu SM, Pierson T, Menke H. [Danger in the pocket: explosive e-cigarette]. HANDCHIR MIKROCHIR P 2020; 52:490-496. [PMID: 33291166 DOI: 10.1055/a-1291-1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Be it as a nicotine replacement or a fashionable seduction for young people or casual smokers with or without nicotine additives - the popularity of e-cigarettes in Europe has increased during the past decade. In addition to the potential of long-term pulmonary damage, which is still largely unknown to date, there is a risk of battery explosion with specific injury patterns. Most users are unaware of the danger in their pockets. MATERIAL AND METHODS Between February and July 2019, four patients were treated with burns from exploded e-cigarettes in the burn centre at Sana Hospital in Offenbach am Main (Germany). This article describes the cause and extent of the injury and its treatment. RESULTS In all patients, the cause of the explosion was what is called "thermal runaway" (very rapid discharge of the battery). The average age of the patients, who were exclusively male, was 37 (25-50) years. The combustion depth ranged from grade I to deep grade IIb. The burnt body surface averaged 3 % (0.5-4.5 %) TBSA and affected the body regions that are typically in direct contact with the e-cigarette: thighs, genitals and hands. Conservative treatment was successful in one case and surgical treatment in two cases (two alloplastic covers, one meshed split-skin transplant). One patient discharged himself from hospital against medical advice after initial treatment. The average time in hospital for the three remaining patients was 15.6 days (6-17). CONCLUSION Burns from an exploding e-cigarette represent a rare new entity. The force of the explosion of the battery body leads to injury patterns that require treatment in specialised centres with the entire spectrum of burn care. Mixed injuries with deep burns occur at the predilection sites due to thermal action, colliquative necrosis due to leaking electrolyte fluid and contamination by foreign bodies (metallic lithium, splinters of the destroyed housing) and require special initial measures. The extinction of fire caused by e-cigarettes also requires special measures. Proper handling of CE-certified devices is essential. Manipulation of the device in the event of defective functions or defective batteries is highly dangerous and should be strictly prohibited. General security requirements must be observed.
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Affiliation(s)
- Philippe Welter
- Sana Klinikum Offenbach GmbH, Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Zentrum für Schwerbrandverletzte
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Figueredo CA, Abdelhay N, Figueredo CM, Catunda R, Gibson MP. The impact of vaping on periodontitis: A systematic review. Clin Exp Dent Res 2020; 7:376-384. [PMID: 33274850 PMCID: PMC8204026 DOI: 10.1002/cre2.360] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background and objective While tobacco cigarette smoking has been proven to be a risk factor for periodontitis, limited information is available regarding vaping, a new alternative to smoking that has been branded as less harmful. Several important in vitro studies have shown that vaping has a similarly damaging effect as cigarette smoking on the health of the periodontium. However, a comprehensive review is lacking in this field. Therefore, we aimed to systematically review the literature about the impact of vaping on periodontitis. Methods The research question was created using the PICOs format. A systematic search of the following electronic databases was performed up to March 2020: Medline, Embase, PubMed, Cochrane, and grey literature. Human studies that assessed periodontal status (plaque index, bleeding on probing, clinical attachment loss, marginal bone loss, and probing depth) in e‐cigarette users compared to non‐smokers (control group) were assessed based on an estimate of fixed effects. The weights of the studies were calculated based on their risks of bias. Results After duplicates were removed, 1,659 studies were screened and 8 case–control studies that investigated the relationship between vaping and periodontal parameters in humans were selected after their risk of bias assessment. Estimated effects of vaping after weighting results based on their standard deviation showed increased plaque, marginal bone loss, clinical attachment loss, pocket depth, and reduced bleeding on probing. Conclusion This study concluded that there is not enough evidence to fully characterize the impacts of vaping on periodontitis. However, within the limitations of our review and the selected included studies, the available results point to increased destruction of the periodontium leading to the development of the disease.
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Affiliation(s)
| | - Nancy Abdelhay
- Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
- Faculty of DentistryAlexandria UniversityEgypt
| | | | - Raisa Catunda
- Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
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Fakeh Campbell ML, Sansone A, Gonzalez LN, Schroth KRJ, Shendell DG. E-cigarette environmental and fire/life safety risks in schools reported by secondary school teachers. BMC Public Health 2020; 20:1215. [PMID: 32770976 PMCID: PMC7414759 DOI: 10.1186/s12889-020-09319-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background To identify if e-cigarette usage is an on-campus problem for secondary schools and evaluate initial school survey responses. More specifically, this survey can aid in identifying where students are seen using e-cigarettes, if smoke alarms have been newly inserted on school property, if smoke alarms have been tampered with to allow for vaping without detection; and, if any e-cigarette fires or explosions have occurred on school property. Methods This survey, disseminated to New Jersey secondary school teachers across seven sessions January–July 2019, resulted in 104 complete responses of 109 respondents. The survey was conducted after fire prevention, exit/egress, and life safety portions of “OSHA 10 Plus for General Industry” courses. Survey questions included number of times teachers observed students vaping and location where vaping in last 12 months, fire alarm installation and tampering, and fires or explosions and injuries from vaping/e-cigarette devices. Results Many (63%) respondents reported very or moderately common rates of vaping within their schools; however, three of four questions regarding school fire and smoke alarm use specifically to detect vaping had a majority of unsure/I don’t know responses. Conclusion Results suggested concerns regarding student vaping and e-cigarette use inside and outside secondary schools. Improved school detection and response are warranted. Trial registration Not applicable.
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Affiliation(s)
- Maryanne L Fakeh Campbell
- New Jersey Safe Schools Program (NJSS), Rutgers School of Public Health (SPH), 683 Hoes Lane West, 3rd Floor SPH - Suite 399, Piscataway, New Jersey, 08854, USA
| | - Andrew Sansone
- New Jersey Safe Schools Program (NJSS), Rutgers School of Public Health (SPH), 683 Hoes Lane West, 3rd Floor SPH - Suite 399, Piscataway, New Jersey, 08854, USA.,Department of Environmental and Occupational Health, Rutgers SPH, 683 Hoes Lane West, 3rd Floor SPH Building, Piscataway, New Jersey, 08854, USA
| | - Lauren N Gonzalez
- New Jersey Safe Schools Program (NJSS), Rutgers School of Public Health (SPH), 683 Hoes Lane West, 3rd Floor SPH - Suite 399, Piscataway, New Jersey, 08854, USA
| | - Kevin R J Schroth
- Department of Health Behavior, Society and Policy, Rutgers SPH, 683 Hoes Lane West, 3rd Floor SPH Building, Piscataway, New Jersey, 08854, USA.,Center for Tobacco Studies, Rutgers SPH, New Brunswick, New Jersey, 08903, USA
| | - Derek G Shendell
- New Jersey Safe Schools Program (NJSS), Rutgers School of Public Health (SPH), 683 Hoes Lane West, 3rd Floor SPH - Suite 399, Piscataway, New Jersey, 08854, USA. .,Department of Environmental and Occupational Health, Rutgers SPH, 683 Hoes Lane West, 3rd Floor SPH Building, Piscataway, New Jersey, 08854, USA. .,Environmental and Occupational Health Science Institute (EOHSI), Rutgers Biomedical and Health Sciences, 170 Frelinghuysen Road, Piscataway, New Jersey, 08854, USA.
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Hendricks KJ, Temples HS, Wright ME. JUULing Epidemic Among Youth: A Guide to Devices, Terminology, and Interventions. J Pediatr Health Care 2020; 34:395-403. [PMID: 32564873 DOI: 10.1016/j.pedhc.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
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Tzortzi A, Kapetanstrataki M, Evangelopoulou V, Behrakis P. A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2248. [PMID: 32230711 PMCID: PMC7177608 DOI: 10.3390/ijerph17072248] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016-2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.
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Affiliation(s)
- Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
| | - Melpo Kapetanstrataki
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Vaso Evangelopoulou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Panagiotis Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
- Pulmonary Department, Athens Medical Center, Distomou 5-7, Marousi, 15125 Athens, Greece
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Claes KEY, Vyncke T, De Wolf E, Hoeksema H, Verbelen J, Monstrey S. Enzymatic debridement as an effective treatment for combined flame and chemical burns caused by e-cigarettes. Am J Emerg Med 2020; 38:1199-1202. [PMID: 32139205 DOI: 10.1016/j.ajem.2020.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/17/2022] Open
Abstract
Since its introduction on the market in 2007, the number of reports on injuries caused by the ignition or explosion of electronic nicotine delivery systems (ENDS) has increased significantly. Two male patients have been treated at our burn center, the for ENDS-related injuries. Their batteries came into contact with metal objects stored in their pants pockets, resulting in a short circuit and finally ignition. In both patients, the combined flame and chemical burn wounds were initially irrigated with water upon arrival at the emergency department, leading to increased levels of pain. In our burn center, the wounds were extensively cleansed which led to a subsequent drop in NRS-scores. Laser Doppler Imaging showed a clear indication for surgery as both patients suffered a partial-thickness burn, with one patient having a patch of full-thickness burn as well. We swiftly performed an enzymatic debridement in both patients, followed by conservative wound management. Although enzymatic debridement is not generally recommended in the treatment of chemical burns, we successfully made use of this treatment option. Different authors advocate the use of mineral oils to irrigate or cover alkali burns, as contact between the chemical compounds and water can set off an exothermic reaction, leading to further injury. We believe that a hypertonic rinsing solution could be recommended as well in an emergency setting and we want to stress the importance of rapid removal of the chemical compounds in suspected chemical burns as well as swift debridement.
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Affiliation(s)
- Karel E Y Claes
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Tom Vyncke
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Edward De Wolf
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Henk Hoeksema
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Jozef Verbelen
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stan Monstrey
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
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Thermal and chemical burns caused by e-cigarette battery explosions. ANN CHIR PLAST ESTH 2020; 65:24-30. [DOI: 10.1016/j.anplas.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 12/23/2022]
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Burns caused by electronic vaping devices (e-cigarettes): Discussion about a new classification proposal based on mechanisms. Burns 2019; 46:243-244. [PMID: 31839502 DOI: 10.1016/j.burns.2019.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022]
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Seitz CM, Kabir Z. Burn injuries caused by e-cigarette explosions: A systematic review of published cases. Tob Prev Cessat 2018; 4:32. [PMID: 32411858 PMCID: PMC7205087 DOI: 10.18332/tpc/94664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION E-cigarettes have the potential to cause burns from batteries that explode. Although e-cigarette explosion burns have been reported by the media (e.g. local online news, blogs), there is a need for a comprehensive review of published medical case reports regarding these injuries. METHODS CINAHL and PubMed were systematically searched using common terms regarding e-cigarettes (electronic cigarette, e-cigarette, vape, vaping, electronic nicotine delivery systems) in every combination with the term ‘explosion’. Peer-reviewed articles were included if they: were written in English, described case reports of burn injuries caused by e-cigarette explosions, and were published in any year. Cases were categorized by demographics, location of the e-cigarette explosion, burned body areas, types of burns, total body surface area of burns, the need for skin grafting, and the length of hospital stay. RESULTS Thirty-one articles were included in the review and described 164 cases. Most patients (90%) were male and between 20 to 29 years old. In the majority of cases (65%), e-cigarettes exploded in pockets, compared to exploding in the face or hand. Common burned areas included the thigh, hand, genitals, and face. Burn severity was typically second-degree burns (35%) or a combination of second-degree and third-degree burns (20%). In all, 48 patients required skin grafting, with 19 reporting a median hospital stay of 5 days. CONCLUSIONS This review has several implications, including the need for regulation of batteries, education regarding battery safety, and leveraging images of the severity of e-cigarette explosion burns to discourage the use of e-cigarettes.
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Affiliation(s)
- Christopher M Seitz
- Department of Health & Exercise Science, Appalachian State University, Boone, North Carolina, United States
| | - Zubair Kabir
- School of Public Health, University College Cork, Ireland
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14
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Satteson ES, Walker NJ, Tuohy CJ, Molnar JA. Extensive Hand Thermal and Blast Injury From Electronic Cigarette Explosion: A Case Report. Hand (N Y) 2018; 13:NP1-NP5. [PMID: 29192506 PMCID: PMC5987979 DOI: 10.1177/1558944717744333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: As the use of electronic cigarettes rises, more reports of injuries related to device explosion are surfacing. Methods: Presented here is the case of a 35-year-old man sustaining extensive thermal and blast injuries to his hand when the device exploded while he was holding it. He required multiple surgeries involving groin flap coverage, tendon transfer, and nerve grafting to optimize his postinjury function. Results: While much of his hand function has been restored, he has continued deficits in range of motion and sensation as a result of the incident. Conclusions: With increasing numbers of such injuries, hand surgeons must be aware of the blast mechanism involved so as to avoid missing deep soft tissue injury or disruption of deep structures, as demonstrated in this case.
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Affiliation(s)
- Ellen S. Satteson
- Wake Forest University School of Medicine, Winston-Salem, NC, USA,Ellen S. Satteson, Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Medical Center Boulevard, 5th Floor Janeway Tower, Winston-Salem, NC 27103, USA.
| | | | | | - Joseph A. Molnar
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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15
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Maraqa T, Mohamed MAT, Salib M, Morris S, Mercer L, Sachwani-Daswani GR. Too Hot for Your Pocket! Burns From E-Cigarette Lithium Battery Explosions: A Case Series. J Burn Care Res 2017; 39:1043-1047. [DOI: 10.1093/jbcr/irx015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tareq Maraqa
- Trauma Services, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint
| | - Mohamed A T Mohamed
- Trauma Services, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint
| | - Mina Salib
- Trauma Services, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint
| | - Stephen Morris
- Trauma Services, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint
| | - Leo Mercer
- Trauma Services, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint
| | - Gul R Sachwani-Daswani
- Trauma Services, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint
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16
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Serror K, Chaouat M, Legrand MM, Depret F, Haddad J, Malca N, Mimoun M, Boccara D. Burns caused by electronic vaping devices (e-cigarettes): A new classification proposal based on mechanisms. Burns 2017; 44:544-548. [PMID: 29056367 DOI: 10.1016/j.burns.2017.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/02/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
Introduction With more than 10 million of daily users, e-cigarettes encountered a great success. But in the past few years, the number of medical reports of injuries caused by the explosion of e-cigarettes has significantly increased. This article aims at reporting our series and reviewing the literature to propose a new classification based on the mechanisms of injuries related to e-cigarettes that can guide non-specialists and specialists in the management of these patients. Method We performed a retrospective review of our institutional burn database from June 2016 to July 2017 for injuries caused by or in the context of using an e-cigarette. The patients' demographics (age, gender), burn injury mechanisms, depth, localization, surface and interventions were described. Results Ten patients suffered from burns related to the use of e-cigarettes. The burns were located at the thigh (80%) and the hand (50%) with a mean surface of 3% of TBSA. Four different mechanisms could be described: Type A: thermal burns with flames due to the phenomenon of "thermal runaway", Type B: blasts lesions secondary to the explosion, Type C: chemical alkali burns caused by spreading of the electrolyte solution and Type D: thermal burns without flames due to overheating. These different mechanisms suggest specific surgical and non-surgical management. Conclusion Management of injuries sustained from e-cigarettes' explosions should be approached from the standpoint of mechanisms. Different mechanisms could be associated and should be considered in specific management.
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Affiliation(s)
- K Serror
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France.
| | - M Chaouat
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Matthieu M Legrand
- Departement of Anesthesiology and Intensive Care Unit, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - F Depret
- Departement of Anesthesiology and Intensive Care Unit, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - J Haddad
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - N Malca
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - M Mimoun
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - D Boccara
- Department of Plastic Reconstructive Surgery, Burn Center, Hôpital Saint Louis, AP-HP 1 Avenue Claude Vellefaux, 75010 Paris, France
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17
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Chun LF, Moazed F, Calfee CS, Matthay MA, Gotts JE. Pulmonary toxicity of e-cigarettes. Am J Physiol Lung Cell Mol Physiol 2017; 313:L193-L206. [PMID: 28522559 PMCID: PMC5582932 DOI: 10.1152/ajplung.00071.2017] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/24/2017] [Accepted: 05/16/2017] [Indexed: 01/31/2023] Open
Abstract
Electronic cigarettes (e-cigarettes or e-cigs) are designed to heat and aerosolize mixtures of vegetable glycerin, propylene glycol, nicotine, and flavoring additives, thus delivering nicotine by inhalation in the absence of combustion. These devices were originally developed to facilitate smoking cessation and have been available in the United States for over a decade. Since 2010, e-cig use has expanded rapidly, especially among adolescents, despite a paucity of short- and long-term safety data. Patterns of use have shifted to include never smokers and many dual users of e-cigs and combustible tobacco products. Over the last several years, research into the potential toxicities of e-cig aerosols has grown exponentially. In the interim, regulatory policymakers across the world have struggled with how to regulate an increasingly diverse array of suppliers and products, against a backdrop of strong advocacy from users, manufacturers, and tobacco control experts. Herein we provide an updated review of the pulmonary toxicity profile of these devices, summarizing evidence from cell culture, animal models, and human subjects. We highlight the major gaps in our current understanding, emphasize the challenges confronting the scientific and regulatory communities, and identify areas that require more research in this important and rapidly evolving field.
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Affiliation(s)
- Lauren F Chun
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California
| | - Farzad Moazed
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California
| | - Carolyn S Calfee
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California
| | - Jeffrey E Gotts
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California
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18
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Thigh deep burns caused by electronic vaping devices (e-cigarettes): A new mechanism. Burns 2017; 43:1133-1135. [DOI: 10.1016/j.burns.2017.01.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/20/2022]
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