Case Report: Neonate With Stridor and Subcutaneous Emphysema as the Only Signs of Physical Abuse

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

Reports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

Subcutaneous emphysema and vocal fold paresis as a complication of a dental procedure

Third molar extraction is a common oral surgery performed in the pediatric population. Here we report a case of extensive subcutaneous emphysema of the orbital, masticator, parapharyngeal, retropharyngeal spaces, bilateral carotid and visceral spaces, and pneumomediastinum after third molar extraction with turbine drill. This was treated with intubation for airway protection, transoral drainage, and intravenous antibiotics. After discharge the patient reported persistent dysphonia and was found to have left vocal fold paresis. This was likely related to extensive pneumomediastum causing injury to the recurrent laryngeal nerve. This is the first report of cervicofacial emphysema leading to vocal cord paresis after third molar extraction, demonstrating the importance of serial clinical monitoring in these cases.