Self-induced subcutaneous facial emphysema in a prisoner: report of a case

Patient-induced progressive facial subcutaneous emphysema masquerading as odontogenic abscess

Facial subcutaneous emphysema (SE) is an uncommon sequelae of dental procedures and often attributed to the use of high-speed air-driven handpieces during surgical extractions, forcing air through fascial spaces. Rarely have there been documented cases of patient-induced SE. In this case report, we present an 18-year-old woman who was referred to the emergency department with a 5-day history of progressive swelling and pain to her right cheek, following a prolonged, but simple extraction of tooth 18. While the dentist and emergency physicians were concerned about an infectious aetiology, history taking, clinical review and imaging corroborated the diagnosis of patient-induced SE secondary to habitual straw use. This report highlights the need for routine postextraction counselling of sinus precautions irrespective of extraction complexity. Additionally, emergency physicians should be aware of SE masquerading as other pathology, including odontogenic abscesses, allergic reactions, angioedema and gas-forming bacterial infections, such as necrotising fasciitis, to ensure appropriate treatment is provided to patients.

Cervicofacial emphysema following unilateral external dacryocystorhinostomies: A case report

Cervicofacial emphysema (CFE), mostly seen after trauma or dental procedures, is an unexpected, extremely rare condition after uncomplicated dacryocystorhinostomy (DCR). It may be misdiagnosed as angioedema or necrotizing fasciitis. In this article, we present the case of a 40-year-old female with CFE twice after uncomplicated unilateral DCR for left and right sides on different operative days. CFE was confirmed by computed tomography, demonstrating extensive air within subcutaneous tissues of the face, neck, and orbital cavity. Subcutaneous crepitation supported the diagnosis. This is the first case report, to the best of our knowledge, describing a patient with recurrent massive CFE after each unilateral DCR.

Where Is the Air Coming From? A Case Report of an Adolescent With Cervicofacial Emphysema

Cervicofacial subcutaneous emphysema is uncommon in children and adolescents. When it occurs, it is often a result of trauma, surgery, or complication of pneumomediastinum. We report a case of an adolescent with isolated cervicofacial emphysema likely from an ulcer in his buccal mucosa.

Facial self-mutilation: an analysis of published cases

OBJECTIVES

Facial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in terms of its comorbidities, and to outline the different types of facial mutilation, as well as the basic approach to the patients with facial self-mutilation.

METHODS

We undertook a review of all published cases of facial self-mutilation (1960-2011).

RESULTS

We identified 200 published cases in 123 relevant papers. Four major groups of comorbidities emerged: psychiatric, neurological and hereditary disorders, and a group of patients without identified comorbidities. There were three general patterns of facial self-mutilation: (1) major and definitive mutilation, with the ocular globe as primary target--seen in patients with psychotic disorders; (2) stereotypical mutilation involving the oral cavity and of variable degree of severity, most often seen in patients with hereditary neuropathy or encephalopathy; (3) mild chronic self-mutilation, seen in patients with non-psychotic psychiatric disorders, acquired neurological disorders, and patients without comorbidities. About 20% of patients that mutilated their face also mutilated extra-facial structures. Patients with psychiatric conditions, especially those with psychotic disorders, had significantly higher (p<0.05) rates of permanent facial self-mutilation than others. Most treatment plans were very individually based, but some principles, such as prevention of irreversible loss of function and structure, or development of infection are applicable to all patients with facial self-mutilation.

CONCLUSIONS

Facial self-mutilation is a potentially severe manifestation of diverse conditions. Several aspects of facial self-mutilation remain to be fully characterised from a clinical perspective.