Case Of Subcutaneous Emphysema Research Articles

Subcutaneous Emphysema Around the Cochlear Implant

Subcutaneous emphysema is usually induced by trauma, infection with gas-forming organisms, or surgical interventions. Few cases have been reported with subcutaneous emphysema after cochlear implantation. Here, we present two cases of subcutaneous emphysema with two distinct etiologies. One case presented with recurrent, bilateral, self-limiting, and mild swelling around the internal receiver stimulator of the cochlear implant. In-depth history taking of this patient revealed that each episode of this swelling was preceded by an upper respiratory tract infection, associated with forceful sneezing and coughing. This patient was managed conservatively. The other case had a long history of otorrhea, for which he did not seek medical attention. The patient presented with painful swelling over the internal receiver stimulator. Moreover, the underlying cause of the subcutaneous emphysema was found to be a cholesteatoma. This patient was managed surgically with the preservation of the device.

Pneumoperitoneum, pneumoretroperitoneum, pneumo-mediastinum, pneumothorax, and extensive subcutaneous emphysema caused by wisdom tooth extraction

Pneumoperitoneum is mainly caused by viscus perforation, in most cases by ulcer. However, it may be caused by non-surgical causes in 10 % of the cases, such as patients on respiratory support, renal dialysis, paracentesis, and anaerobic bacterial infections. In addition, there are some sporadic causes of pneumoperitoneum; one of them is wisdom tooth extraction, which is described in our case. In the literature review, there were many documented cases of subcutaneous emphysema, pneumothorax, and pneumomediastinum caused by wisdom tooth extraction. However, there was only one case that represented pneumoperitoneum after that procedure. In this case report, We are reporting a case of a 50-year-old male patient who presented one-week status post wisdom tooth extraction, with significant subcutaneous emphysema involving the face, neck, and upper chest; further workup and assessment showed that the patient has considerable pneumoperitoneum, pneumomediastinum, mild pneumothorax bilaterally, and extensive subcutaneous emphysema on computerized tomography. The patient was managed conservatively, with no need for any surgical intervention, and he was discharged home in a good general condition.

A Report of 61 Cases of Retroperitoneal Laparoscopic Nephron-Sparing Surgery and Factors Affecting Postoperative Renal Function.

Objective To explore the situation of 61 patients with renal tumors who underwent retroperitoneal laparoscopic nephron-sparing surgery (RLNSS) and the factors affecting postoperative renal function. Methods A total of 61 patients with renal tumors who underwent RLNSS in our hospital from January 2018 to January 2021 were included in this study. All patients were treated with RLNSS. The clinical data of patients were recorded. Before operation and 3 months after operation, the change value of glomerular filtration rate (ΔGFR) was measured by the Gates method. Multivariate linear regression was used to analyze the related factors affecting postoperative renal function. Results All 61 patients successfully completed the operation. The mean operative time was 60–150 min‚ average (98.75 ± 14.38) min. The estimated intraoperative blood loss was 20–310 ml‚ average (107.93 ± 68.55) ml. Intraoperative warm ischemia time (WIT) was 0–39 min, with an average of (21.16 ± 6.47) min. All patients' pathological margins were negative after operation. In all patients, there were 5 postoperative complications, including 2 cases of renal wound bleeding (3.28%), 1 case of hematuria (1.64%), 1 case of urinary fistula (1.64%), and 1 case of subcutaneous emphysema (1.64%). There were significant differences in tumor diameter, preoperative GFR, operation time and WIT (P < 0.05). Multivariate analysis showed that tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS (P < 0.05). Conclusion RLNSS has a good curative effect on patients with renal tumor, and tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS.

Three-Dimensional Computed Tomography Bronchography and Angiography-Guided Thoracoscopic Segmentectomy for Pulmonary Nodules.

Three-dimensional computed tomography bronchography and angiography (3D-CTBA) provides detailed imaging information for pulmonary segmentectomy. This study was performed to verify the feasibility of 3D-CTBA-guided thoracoscopic segmentectomy for the treatment of pulmonary nodules. A retrospective analysis was performed on all patients who underwent 3D-CTBA-guided uniport thoracoscopic segmentectomies or subsegmentectomies for pulmonary nodules in the period from May 2019 to May 2020. All of the information related to perioperative management and surgical operations was retrieved from the medical records and operating notes for detailed analysis. A total of 104 eligible operations involving the resection of 110 nodules with diameters in the range of 5-20mm were included. Under 3D-CTBA guidance, the pulmonary nodules were located with an accuracy of 100% (110/110) and the median resection margin was 24.3mm (17-33mm). Additionally, the segmental (subsegmental) bronchi, arteries, and veins were identified with accuracy rates of 100% (104/104), 96.2% (100/104), and 94.2% (98/104), respectively. The postoperative complications consisted of 3 cases of pulmonary infection (2.9%), 6 cases of arrhythmia (5.8%), 2 cases of hemoptysis (1.9%), 4 cases of air leak (3.8%), and 2 cases of subcutaneous emphysema (1.9%). No perioperative death occurred. 3D-CTBA-guided thoracoscopic segmentectomy is an effective surgical approach for the management of pulmonary nodules.

Extensive subcutaneous emphysema after exodonty of molar third parties: Case report

Introduction: Subcutaneous emphysema is an accident where the forced introduction of air into the tissues occurs, which in dentistry can appear after the use of a high-speed pen or triple syringe. The swelling associated with emphysema can be mistaken for bruising, allergies or infections. The differential diagnosis is often related to the presence of crackles on palpation, associated or not, with pain. Treatment is prophylactic and palliative, since the problem tends to resolve spontaneously. Objective: To report a clinical case of subcutaneous emphysema and extraction of third molars, discussing the importance of differential diagnosis to guide the treatment of this complication. Case report: A 22-year-old female patient attended the oral and maxillofacial surgery service of a public hospital in Recife-PE, complaining of pain in the lower left third molar region. During the surgical procedure, it was necessary to use a high-speed pen to perform osteotomy and odontosection of tooth 38. At the end of the surgery, there was an increase in volume in the left periorbital region, compatible with subcutaneous emphysema. After 7 days postoperatively, spontaneous resolution of emphysema was observed. Discussion: According to the current literature, after the emphysema is already under a dermal layer, the air may remain at the surgery site or continue to spread along the facial spaces, depending on the permanence of the air jet. Conclusion: The correct diagnosis of subcutaneous emphysema was effective in ruling out other complications, guiding the management of the reported case, in addition to preventing the emphysema from evolving to an infection involving the cervicofacial or thoracic region.

Pulmonary barotrauma in acute respiratory distress syndrome: A case of subcutaneous emphysema, pneumomediastinum, and pneumothorax

Pulmonary barotrauma in acute respiratory distress syndrome: A case of subcutaneous emphysema, pneumomediastinum, and pneumothorax

Comparison of Totally Extraperitoneal versus Transabdominal Preperitoneal repair of inguinal hernias

Introduction: Laparoscopic inguinal hernia repair is a tension-free mesh repair that is based on pre-peritoneal approach of repair. It provides mechanical advantage to the surgeon, by being able to place a large piece of mesh and by using the natural force of the abdominal wall to disperse the intra-abdominal pressure over a large area to support the mesh. This retrospective study is aimed to study the demography of inguinal hernia and to compare operating time, complications and postoperative pain between patients undergoing Total Extrapritoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair.Methods: A retrospective comparative study was conducted in patients with inguinal hernia who underwent laparoscopic repair by either TEP or TAPP, between April 2019 to July 2020 at Nobel Medical Collage Teaching Hospital, Biratnagar, Morang. Age, sex, type of hernia, duration of operation, post-operative complications, severity of pain and duration hospital stay were analyzed between two groups of patients undergoingsurgery by either TEP or TAPP.Results: One hundred and five patients underwent either TEP or TAPP during study period. There were 96 males and 9 females. There were 50 patients with right, 40 with left and 6 patients with bilateral inguinal hernia. Four patients had left sided irreducible inguinal hernia, 2 patients had bilateral recurrent inguinal hernia, 2 patients had right sided recurrent inguinal hernia and 1 patient had left sided recurrent inguinal hernia.There was significant difference in duration of operation (TEP 64.43min) / (TAPP 84.46min), p&lt;0. 001. Total duration of hospital stay and postoperative pain were not significant between patients operated with TEPor TAPP. Accidental pneumoperitoneum was noticed in 8 cases, 10 cases of subcutaneous emphysema, 5 cases of seroma and 1 case of scrotal hematoma in TEP group. In TAPP group scrotal hematoma occurred in 4 cases and seroma in 5 cases which was not significantly different from TEP group.Conclusion: TAPP had significantly longer operating time as compared to TEP. However, there was no significant difference in post-operative pain and hospital stay in both group.

Pneumomediastinum, subcutaneous emphysema and pneumorrhachis following cocaine insufflation: a case report

A case report on a 36-year-old male patient presenting to the emergency department (ED) with chest tightness, nasal sounding voice and subcutaneous emphysema 72 hours after the nasal insufflation of approximately 0.5g of cocaine. A plain radiograph of the chest demonstrated an extensive pneumomediastinum with subcutaneous emphysema extending into his neck. A computerised tomography (CT) scan confirmed the above findings, along with a pneumorrhachis of the thoracic spine. He was admitted locally for further investigation and observation. Cocaine is the second most used illicit drug in the UK. The associated complications of cocaine can vary from acute coronary syndrome to acute psychosis. Pulmonological trauma secondary to cocaine misuse is commonly associated with inhalation of cocaine; we present this rare case of subcutaneous emphysema, pneumomediastinum and pneumorrhachis secondary to nasal insufflation. It is believed that deep nasal insufflation of cocaine is followed by forceful Valsalva manoeuvre, which allows for the rapid absorption of the drug and increases the euphoric effect. This forceful inhalation can lead to barotrauma and leakage of air into the posterior mediastinum.

Safety of a Novel Microwave Surgical Instrument for Lung Parenchyma Dissection During Segmentectomy

The choice between electrocautery or automatic suturing instruments for dissection of the lung parenchyma along the intersegmental plane during lung segmentectomy remains controversial. We hypothesized that a novel microwave surgical instrument (MSI) for dissecting the lung parenchyma could have excellent sealing effects. We examined the feasibility and safety of lung parenchymal dissection using a MSI during lung segmentectomy. This was a prospective clinical study of lung segmentectomy involving dissection of the entire intersegmental plane using a MSI. Complications related to sealing of the lung parenchyma were evaluated and perioperative outcomes were compared to those of patients who underwent lung segmentectomy using automatic suturing instruments. Propensity score-matched comparisons were used to assess the potential impact of selection bias. Lung segmentectomy using a MSI was successfully performed in 30 patients. According to the propensity score matching analysis, intraoperative blood loss, length of hospital stay, and postoperative complications of the microwave group were significantly lesser (P= .019, .003, and .008, respectively) compared to those of the control group (n= 66). Prolonged air leakage was not observed. There were two cases of subcutaneous emphysema after removal of the chest tube, but no other grade 2 or higher complications were observed. No mortality occurred within 30 or 90 days postoperatively. The use of a MSI for lung parenchymal dissection was associated with lower blood loss during surgical procedures, reduced air leakage after the operation, and fewer postoperative complications.

Diagnostic utility of medical thoracoscopy in undiagnosed exudative pleural effusions

Background: Medical thoracoscopy is a minimally invasive technique to inspect the pleural space and to perform biopsy of pleural lesions under direct vision. In this study, the diagnostic utility of thoracoscopy for undiagnosed exudative lymphocytic pleural effusions from a tertiary care respiratory center will be discussed. Materials and Methods: In a retrospective analysis of thoracoscopic procedures, we performed between September 2017 and August 2019, the yield of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed exudative lymphocytic pleural effusions was evaluated. Undiagnosed exudative pleural effusions were defined as pleural effusions where an etiologic diagnosis could not be ascertained by initial pleural fluid biochemical and microbiological analysis, including protein, sugar, lactate dehydrogenase, Gram and acid-fast bacilli stains and Mycobacterium tuberculosis culture, pleural fluid adenosine deaminase levels, and at least two pleural fluid cytologies negative for malignant cells or other definite causes. We analyzed the clinical, radiological, cytological, and histopathological data of the patients and also the complications of thoracoscopy. Results: We performed thoracoscopy in 68 cases of undiagnosed exudative pleural effusions using the rigid thoracoscope. The overall diagnostic yield of thoracoscopic pleural biopsy was 95.6% in patients with undiagnosed exudative pleural effusions. Malignant pleural effusion was diagnosed in 67.6% of patients, while tuberculosis was diagnosed with pleural biopsy in 25% of patients. Three cases of subcutaneous emphysema, 2 cases of postprocedure fever were observed, and one patient had prolonged air leak. Conclusion: Medical thoracoscopy has a good diagnostic yield in patients with undiagnosed exudative lymphocytic pleural effusions and is a safe procedure as well.

A case of subcutaneous emphysema during dental treatment

A case of subcutaneous emphysema during dental treatment

The causes of subcutaneous emphysema of relevance to dental practitioners?

Data sources An electronic search was conducted using EMBASE, LILACS, PubMed, SciELO, Scopus, Web of Science, and two grey literature data sources. All issues of nine dentistry journals and relevant chapters in four endodontic textbooks were manually searched.Study selection Abstracts of all the studies that were identified during the electronic and manual searches were obtained and screened independently by two reviewers in order to select clinical studies, case series, or case reports describing subcutaneous emphysema that occurred in adult patients during or immediately after root canal treatment.Data extraction and synthesis Predetermined data were extracted from each study independently by two reviewers and organised into data tables. All disagreements were resolved through discussion with a third reviewer. The data obtained were combined through a narrative synthesis.Results Following full-text evaluation according to the inclusion criteria, 51 articles that described 65 cases of subcutaneous emphysema were included. There were 36 case reports and 15 case series. The condition was mainly reported in female patients and maxillary teeth. While the age of the patients ranged from 18 to 63 years, this demographic information was missing from a few studies. Details on the involved tooth and diagnosis were also missing from several articles. In most of the cases, subcutaneous emphysema developed during initial root canal treatment. The diagnosis was mainly based on intraoral, plain facial, neck, or chest radiographs, while computed tomography (CT) scans were obtained in fewer cases. The majority of the patients were referred to a different practice, a hospital or university clinic for the management of the condition by more specialised healthcare practitioners. In addition to drying root canals using air pressure, irrigation with hydrogen peroxide, and the air-water spray produced by handpieces, it was reported that laser-produced spray and ozone gas infiltration may also be the culprits of subcutaneous emphysema. The signs and symptoms resolve within 17 days. Its management mostly remains empirical and involves the use of antibiotics, analgesics, local application of cold or hot compresses, or administration of oxygen and hospitalisation, among other methods.Conclusions The systematic review showed that subcutaneous emphysema can occur during both surgical and nonsurgical endodontic treatment. Air streams or air-water sprays should not be directed toward the root canals or areas with mucosal discontinuity. None of the management approaches were clearly associated with a faster recovery. The review asked for developing guidelines in order to avoid unnecessary or potentially harmful interventions.

A Case of Subcutaneous Emphysema and Pneumomediastinum after Palatine Tonsillectomy

A Case of Subcutaneous Emphysema and Pneumomediastinum after Palatine Tonsillectomy

Powered endoscopic dacryocystorhinostomy (DCR), raising the bars

Abstract Introduction: This study is done to assess the efficacy of powered endoscopic dacryocystorhinostomy (DCR) with large bony ostium exposing of fundus of sac and primary mucosal anastomosis. The study involved prospective interventional case series with short perioperative follow up. Materials and Methods: Operative and postoperative data were prospectively collected on 42 patients (15 men and 27women; mean age, 62.4 y; range 14–91 y) who presented to a lacrimal clinic with epiphora and obstruction of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. All surgeries done by the same surgeon by standardized surgical technique. Follow?up evaluations included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit. Results: The only surgical complication was one case of sub cutaneous emphysema. 39 of the 42 DCRs had anatomically patent naso lacrimal duct after a mean follow?up of 12 months (standard deviation = 5 months), yielding a success rate of 95.7%. Out of three failures two had closed ostium because of improper use of medications, one patient had granulation tissue at the ostium. Two patients with a patent ostium had functional block and continued to have some symptoms. Conclusion: Powered endoscopic DCR which meets the with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR. Keywords: Endonasal DCR, Powered DCR, Dacryocystorhinostomy. Introduction Dacryocystorhinostomy (DCR) is surgical procedure done for epiphora due to nasolacrimal duct obstruction (NLDO), which involves creating a fistulous opening between lacrimal sac and nasal cavity at the level of middle meatus. There are various procedures to create this ostium that is external DCR, endoscopic nasal DCR, laser DCR. The most accepted are external and endonasal DCR. Endonasal DCR in

A case of subcutaneous emphysema caused by nose blowing after lower third molars extractions

A case of subcutaneous emphysema caused by nose blowing after lower third molars extractions

Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study.

Background Submucosal tumors (SMTs) are primarily benign tumors, but some may have a malignant potential. Endoscopic submucosal dissection that has been used for removing esophageal SMTs could cause perforation. Submucosal tunnel endoscopic resection (STER) is an improved and an effective technique for treating esophageal SMTs. Aims This study was conducted to evaluate the efficacy and safety of STER for treating esophageal SMTs. Methods A retrospective study design was adopted to analyze the baseline characteristics, clinical outcomes, and follow-up data of patients with esophageal SMTs, which originated from the muscularis propria layer and were treated with STER from September 2011 to May 2018. Results A total of 119 lesions were included from 115 patients who were successfully treated with STER. The mean age of the patients was 49.7 ± 10.7 years. The lesions were primarily located in the middle and lower esophagus. The mean size of the lesions was 19.4 ± 10.0 mm. The mean operation duration was 46.7 ± 25.6 min, and the mean duration of hospitalization was 5.9 ± 2.8 days. The total en bloc resection rate and the complete resection rate were 97.5% and 100%, respectively. Regarding complications, there were 9 (7.8%) cases of perforation, 2 (1.7%) cases of pneumothorax, and 9 (7.8%) cases of subcutaneous emphysema. Histopathological results revealed 113 (95.0%) cases of leiomyoma, 5 (4.2%) cases of gastrointestinal stromal tumors, and 1 (0.8%) case of a granular cell tumor. During the mean 15-month follow-up, there were no cases of recurrence and distant metastasis. Conclusions STER is a safe and feasible technique for treating esophageal SMTs originating from the muscularis propria layer.

Emphysema following air-powder abrasive treatment for peri-implantitis

BackgroundSubcutaneous emphysema refers to swelling caused by the presence of air or gas in the interstices of loose connective tissue. In the head and neck area, it may follow the fascial planes and is characterized by sudden swelling, crepitus on palpation, infrequent pain, and air emboli on radiography. It usually occurs as a complication in dental treatment. Some reports have described subcutaneous emphysema caused by dental procedures; however, severe emphysema related to peri-implantitis after treatment has not been documented. Accordingly, the current report describes a rare case of subcutaneous cervical emphysema resulting from the use of an air-powder abrasive device to treat peri-implantitis.Case presentationBased on a review of the existing literature and the present case, nine cases of subcutaneous emphysema due to air-powder abrasive device have been reported. In most cases, the emphysema resolved over time after treatment with prophylactic antibiotics; among these, two were related to peri-implantitis management.ConclusionConsidering the frequent use of air-powder abrasive devices to treat peri-implantitis, the potential risk of iatrogenic emphysema related to this procedure needs to be addressed more extensively.

A Case of Subcutaneous Emphysema in the External Auditory Canal with Hearing Loss

A Case of Subcutaneous Emphysema in the External Auditory Canal with Hearing Loss

難聴をきたした外耳道皮下気腫例

難聴をきたした外耳道皮下気腫例

Subcutaneous Emphysema During Root Canal Therapy: A Case Report

Cervicofacial subcutaneous emphysema is defined as the abnormal introduction of air in the subcutaneous tissues of the head and neck. It is mainly caused by trauma, head and neck surgery, general anesthesia, and coughing or habitual performance of Valsalva manoeuvre. The occurrence of subcutaneous emphysema after dental treatment is rare, and diffusion of gas into the mediastinum is much rarer, especially when the procedure is a nonsurgical treatment. Presented here is a case of subcutaneous emphysema that occurred after sodium hypochlorite irrigation during endodontic treatment, and the description of its etiologies and prevention during nonsurgical endodontic treatment. Endodontic success can be essentially achieved via good debridement of a root canal, and an ideal endodontic irrigant is effective in removing the smear layer, opening the dentinal tubules, and producing a clean surface for closer obturation. A 60-years-old woman had an abnormal swelling and pain during an endodontic treatment accompanied by her dentist to the emergency room and was referred to our observation for complaining of severe pain, ecchymosis and severe swelling on the left side of her face. The aforementioned symptoms appeared after sodium hypochlorite irrigation and aggressive use of air spray for drying the root canal during the endodontic treatment of the upper left lateral incisor. An extrusion during an inappropriate endodontic treatment may occasionally be reported and can cause tissue damage. NaOCl is one of the best and most commonly used irrigating solutions because of its efficacy, but it can also negatively affect the periapical tissues. Determining the correct working length, even when performing an intraoperative periapical radiograph and confirming the root canal integrity, could help avoid these kinds of accidents.