Abstract
BackgroundSubcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections.Case presentationWe discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces.ConclusionAs an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.
Highlights
Subcutaneous cervicofacial emphysema is a relatively frequent clinical entity and has a large differential diagnosis including, among others: angioedema and/or anaphylactic reaction, deep neck space infections, necrotizing fasciitis, airway trauma, dental or surgical procedures, pneumothorax or pneumomediastinum
Our objective is to report a severe case of subcutaneous emphysema, to review the last 10 years of literature on the topic and to discuss the management of those patients from an otolaryngologist’s point of view
Case report A 76-year-old male presented to the emergency department in our tertiary care center with left-sided cervicofacial subcutaneous emphysema
Summary
Subcutaneous cervicofacial emphysema is a relatively frequent clinical entity and has a large differential diagnosis including, among others: angioedema and/or anaphylactic reaction, deep neck space infections, necrotizing fasciitis, airway trauma, dental or surgical procedures, pneumothorax or pneumomediastinum. Case report A 76-year-old male presented to the emergency department in our tertiary care center with left-sided cervicofacial subcutaneous emphysema. The questionnaire revealed he had sustained a routine dental filling of tooth #34 a few hours before. Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections. We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis This revealed air but no tissue necrosis nor abnormal fluid. Cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces
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