Subcutaneous Cervical and Facial Emphysema with the Use of the Bonfils Fiberscope and High-Flow Oxygen Insufflation

Abstract

We present a case in which use of the Bonfils retromolar intubation fiberscope resulted in cervical and facial subcutaneous emphysema. The patient was a 75-yr-old woman with Mallampati Grade I airway. The Bonfils retromolar intubation fiberscope was used for teaching purposes. Flow on the oxygen port of the fiberscope was set at 10 L/min. Immediately after insertion of the scope, her whole face and cervical skin showed severe subcutaneous emphysema. The patient was intubated conventionally and the emphysema resolved within 24 h. Subcutaneous emphysema after air insufflation is known from dental procedures with air entering through holes in the teeth. In our case, the oxygen insufflation was sufficient to create emphysema, probably through tiny mucosal lesions.