Cervicofacial Emphysema Research Articles

A case of pneumomediastinum after dental root canal treatment

We presented a rare case in which a 27-year-old female patient developed cervicofacial emphysema and pneumomediastinum following dental root canal treatment on her lower right second molar. She presented to the emergency department with facial and neck pain, difficulty in swallowing, and a feeling of tightness and pressure in the chest. Computed tomography revealed free air foci extending from the right mandibular region to the mediastinum. Pneumomediastinum related to dental root canal treatment was considered and the patient was admitted to the thoracic surgery department and oxygen therapy and prophylactic antibiotics were initiated. After 3 days of observation, the emphysema resolved, the symptoms disappeared, and the inflammatory markers remained within normal limits. The patient was discharged in stable condition.

Extensive Cervicofacial Emphysema After Eustachian Tube Balloon Tuboplasty.

Department of Otolaryngology—Head and Neck Surgery, Changi General Hospital, Singapore Address correspondence and reprint requests to Heng Wai Yuen, M.Med. (O.R.L.), F.A.M.S. (O.R.L.), M.H.P.E. (Maastricht), Department of Otolaryngology–Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore; E-mail: [email protected] The authors have no financial disclosures or conflict of interest. Supplemental digital content is available in the text.

Subcutaneous Emphysema of Dental Origin – Two Case Reports with a Comprehensive Review of Literature from 1965 to 2020, with an Emphasis on Timely Management

Subcutaneous emphysema (SE) is a rare but possible complication of dental treatment resulting from the usage of high-speed air-driven instruments and introduction of irrigating solutions like hydrogen peroxide into soft tissues. Two case reports are described here, namely (a) drying of root canals using a three-way syringe by “Venturi” technique and (b) accidental injection of hydrogen peroxide instead of local anesthesia in an infiltration technique. A review of the literature is done wherein a search for terms such as pneumomediastinum, mediastinitis, embolism, or extensive SE (ESC) from 1965 to 2020 using the PubMed search engine was done and the results were tabulated. Since the number of cases and complications reported are on the rise, data regarding diagnosis, investigations, and a management protocol with an emphasis on prevention have been elaborated. Methods such as reductive manipulation or “counter incision,” as incited from medical literature, have been suggested to reduce morbidity and mortality. In both of the case reports, subcutaneous cervicofacial emphysema resolved briefly due to the effectual reduction maneuver implemented promptly.

MULTIPLE CERVICAL SPACES’ SECONDARY EMPHYSEMA CAUSED BY A MANDIBULAR ANGLE FRACTURE FROM ASSAULT, REPORT OF A CASE.

Objectives To present a case of subcutaneous cervicofacial emphysema of a patient with a closed mandibular angle fracture after interpersonal violence. Case Report A 36-year-old male was transferred from a regional hospital after a referred interpersonal violence incident. The patient sustained a fracture of the left mandibular angle, as well as a right clavicular fracture, which was treated conservatively by the referring hospital. As depicted by the CT scan, a large emphysema involving the buccal, submandibular, pterygomasseterial and lateral pharyngeal spaces of the left side. Clinically the patient had a positive Hamman’s sign. An open reduction was decided with internal rigid fixation. The postoperative course was uneventful. Conclusions Cervicofacial emphysema, despite not unusual in fractures involving the midface, due to communication with the paranasal sinuses, is a rather rare complication of mandibular fractures. Proper clinical and imaging examination is required to exclude expansion of the air to the mediastinum, which can be a life-threatening complication.

A Patient with Severe Cervicofacial Subcutaneous Emphysema Associated with Munchausen’s Syndrome: A Case Report

Subcutaneous cervicofacial emphysema is a rare and life-threatening condition that results from various causes. In this report, we documented a case of a patient with severe subcutaneous cervicofacial emphysema a condition that falls under the umbrella of Munchausen’s syndrome and discussed the workup of this patient. Thorough diagnostic investigations seeking the etiology of the condition proved unsuccessful. When faced with cases of recurring subcutaneous cervicofacial emphysema, where the root cause remains ambiguous a diagnosis of Munchausen’s Syndrome should be considered.

Subcutaneous Craniofacial Emphysema Following Endodontic Treatment: Case Report with Literature Review

Subcutaneous emphysema is a well-known and recognized complication in oral surgery, due to high pressure rotating instrument use, mostly related to impacted tooth surgery. Although root canal treatment in endodontic therapy is considered as a safe and standard procedure, affected by a low incidence of complication, subcutaneous emphysema due to the choice of mechanical tools or as a consequence of the use of air stream to dry the operating field should be considered as a potential cause. The air can spread through soft tissue from the apex or from an iatrogenic root perforation, suddenly leading to this unusual complication. It is very important for a dental practitioner to promptly identify the adverse event and to know how to manage this situation. We report a case of a 57-year-old woman with immediate subcutaneous cervicofacial emphysema after root canal therapy of the right inferior second premolar and its management. A brief review of the literature is also displayed.

Iatrogenic cervicofacial emphysema after dental procedures: a case series and radiographic review

Abstract Cervicofacial emphysema (CE) is a rare but dangerous complication of head and neck surgery and injury. CE presents as a pronounced swelling with crepitus that can cause dysphagia and airway deviation secondary to a mass effect. Air can infiltrate potential spaces of the head that are otherwise not present, propagate through the neck, and even travel into the mediastinum through the retropharyngeal space or the danger space. In this report we present two patients who had CE but were erroneously diagnosed with anaphylaxis. We discuss the unique radiographic findings of CE and its management.

Subcutaneous cervicofacial emphysema following thyroid surgery.

Subcutaneous cervicofacial emphysema following thyroid surgery.

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

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.

Endo-buccal mucosal punch biopsy and cervico-facial benign subcutaneous emphysema

Subcutaneous emphysema is a rare feature caused by traumatism (weapons, accidents: crashes, barotrauma, …), dental care and infections. A 48-year-old woman consults for a right oral mucosa lesion and benefits from a biopsy for anatomopathological diagnosis. Within hours of the biopsy, bilateral jugal then cervical swelling has occured without signs of severity. The examination at 48 hours and the CT scan showed a bilateral cervicofacial emphysema with a spontaneous favorable resolution in a few days making the diagnosis of benign subcutaneous emphysema (BSCE). BSE can occurs after an endobuccal biopsy, a close follow up is necessary to rule out gas gangrene.The resolution is spontaneous with the necessity to reassure the patient.

Cervicofacial and mediastinal emphysema after balloon eustachian tuboplasty (BET): a retrospective multicenter analysis.

Balloon Eustachian tuboplasty (BET) is a new treatment modality addressing chronic obstructive dysfunction of the Eustachian tube (ET). So far, BET has been deemed a safe procedure under general anesthesia with only minor adverse effects. However, individual cases of postoperative emphysema have been reported. In the present retrospective multicenter analysis we determined the incidence rate of this potentially life threatening complication after BET. In total we collected data from 3,670 BET procedures performed on 2,272 patients in four tertiary care ENT departments. Ten cases of postoperative cervicofacial emphysema were documented, whereas only in 3 of them a pneumomediastinum was developed. None of the affected patients developed at any time serious clinical signs or symptoms besides cutaneous crepitations. A complete resolution and recovery of the emphysema occurred in all patients under antibiotic prophylaxis and abstinence from Valsalva maneuver within the first 2-6 postoperative days. Possible causes for the development of these postinterventional emphysemas are considered to be mucosal injuries of the ET during manipulations for the correct position of the insertion instrument, through a "kinking" of the balloon catheter or even due to the relative rigid catheter itself, although its form is regarded to be atraumatic. The complication rate of postoperative emphysema was 0.27% (95% CI 0.13-0.50%). The above facts in addition to only minor and transient overall complications after BET reported in literature, can label this procedure as a safe treatment with a low risk profile.

Post-tonsillectomy surgical emphysema \u2014 a case report

Tonsillectomy is still the most common surgical procedure performed in most ENT departments worldwide. Although it is considered a safe procedure, its complications can be serious and potentially life threatening. The development of cervicofacial emphysema after tonsillectomy is a very rare complication, which in most cases resolves spontaneously, but on the other hand it can be life threatening especially if associated with pneumothorax or pneumomediastinum.

Cervicofacial emphysema and pneumomediastinum complicating adenotonsillectomy

Subcutaneous emphysema after adeno-tonsillectomy is rarely encountered. One of such cases following adenotonsilectomy was seen in our institution.We report the case of a 5-year-old girl who developed cervicofacial emphysema and pneumomediastinum following retching and vomiting 6 hours after a routine adenotonsillectomy. Radiograph of the jaws and chest revealed subcutaneous emphysema. Previously published cases showed that the cause was most likely due to air passing into subcutaneous tissue through the tonsillar fossa and superior constrictor muscle into the facial layers of the neck following a bout of coughing and straining (crying), or the use of positive pressure ventilation. The emphysema can then spread to parapharyngeal and retropharyngeal spaces with associated morbidities. Further complications may include pneumothorax and pneumomediastinum and this should be excluded.

An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre

ABSTRACT Aim To discuss a case of spontaneous pneumomediastinum with pneumothorax with subcutaneous emphysema presenting with stridor due to laryngeal edema with relevant review of literature. Background Spontaneous pneumomediastinum is a rare condition that has been described in healthy individuals following Valsalva manoeuvre, excessive and prolonged cough or emesis. Laryngeal involvement in these cases has not been reported so far. Case description We present an interesting case of spontaneous pneumomediastinum with pneumothorax with pneumopericardium and cervicofacial emphysema with suspected ingestion of foreign body. In view of stridor due to laryngeal edema tracheostomy was done. No obvious cause for the air leak was found on further investigations. The foreign body sensation could have led to oral provocative manoeuvres by the patient causing increased intra-alveolar pressures and air leak. Conclusion Spontaneous pneumomediastinum with cervicofacial emphysema with pneumopericardium with laryngeal involvement is very rare. Tracheostomy is essential in case of airway compromise. A thorough evaluation for the underlying condition is essential to prevent further air leak. Clinical significance In a case of spontaneous pneumomediastinum with airway compromise due to involvement of the larynx, tracheostomy is essential to secure the airway and could also help in resolution of emphysema. How to cite this article Pratibha CB, Satish D, Gopal S, Balasubramanya AM. An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre. Int J Otorhinolaryngol Clin 2015;7(2):93-96.

CT Assisted Diagnosis, Management of Soft Tissue Cervicofacial Emphysema and Pneumomediastinum during Root Canal Treatment of an Upper Premolar: A Case Report

Aim: To discuss the iatrogenic cervicofacial emphysema and pneumomediastinum after endodontic treatment of maxillary premolar. Summary: A 25-year-old female was referred to the department with considerable swelling on the right side of face. She gave a history of progressive swelling with mild difficulty in breathing and swallowing 15 minutes after endodontic treatment of an upper right first premolar. The tooth was accessed by a private practitioner using high speed air driven handpiece without the use of rubber dam and compressed air was used to dry the canals. On examination, swelling extended from right peri-orbital region to the neck bilaterally. It was soft, non-erythematous and showed crepitations without pain. The microbiological tests showed no evidence of infection. A Computed tomogram of the thoracocervicofacial region confirmed the diagnosis of cervicofacial emphysema with pneumomediastinum. She was kept on antibiotics and analgesics for 7 and 3 days respectively. Patient showed regression of swelling, dyspnoea and dysphagia on follow up visit after 48 hours. Key learning point: Early diagnosis and management of such cases is of extreme importance to prevent possible cardiopulmonary complications and infections. Computed tomography scans are very useful in diagnosis and to determine the extension of air into the tissue spaces.

Facial, cervical, and mediastinal emphysema of the clarinet player: case report.

Cervicofacial emphysema may arise due to the leakage of air from a defect in the aerodigestive tract to the fascial layers of neck and face. Rarely, it may be caused by insufflation of air through the Stensen's duct. We present a case with diffuse facial, cervical and mediastinal emphysema due to playing a wind instrument immediately after a facial trauma. There was no mucosal defect or laceration noticed by examination which could explain the origin of the emphysema. Despite the widespread cervicofacial emphysema with mediastinal involvement, the patient significantly improved within 48 hours without any intervention. Even though cervicofacial emphysema ameliorates spontaneously, increased care must be taken, especially when there is pneumomediastinum and/or pneumothorax.

Cervicofacial Surgical Emphysema following Tonsillectomy.

We report the case of a patient who developed cervicofacial subcutaneous emphysema following a routine tonsillectomy. An 18-year-old male with swallowing difficulties underwent a tonsillectomy and developed swelling of the right side of his neck and face 36 hours after surgery. A neck X-ray revealed subcutaneous emphysema. Unlike similar previously published cases, there were no postoperative issues of coughing, straining, or use of positive pressure ventilation. The complication also occurred after a considerable length of time. Further complications may include pneumothorax and pneumomediastinum and these should be excluded.

Deep cervicofacial emphysema and pneumomediastinum due to penetrant oral trauma

Introduction: Pneumomediastinum following deep cervicofacial emphysema due to oral trauma is rare. We present a case with an unusual oral trauma and diagnosis and management of complications of injury. case report: A 26-year-old female presented with difficulty in breathing and painful swallowing after an unusual oropharyngeal trauma. computed tomography scans revealed deep cervical emphysema and pneumomediastinum. the laceration in oropharynx repaired and board spectrum antibiotherapy started and the patient had an uneventful recovery. conclusion: Our case is unusual because of the rarity of these complications after oropharyngeal trauma and if pneumomediastinum is misdiagnosed, life-threatening complications may occur. Also conservative treatment in deep cervical emphysema and pneumomediastinum without any life-threatening complication is favorable.

Unusual case of cervicofacial surgical emphysema

Unusual case of cervicofacial surgical emphysema

Subcutaneous Emphysema and Pneumomediastinum after Tonsillectomy

Cervicofacial subcutaneous emphysema is a rare complication of tonsillectomy that often resolves spontaneously but may progress to obstruct upper airways or spread to the thorax causing pneumomediastinum or pneumothorax. The mechanisms by which subcutaneous emphysema and pneumomediastinum may develop after tonsillectomy are poorly understood. A case of a 21-year-old female undergoing routine adenotonsillectomy, who developed cervicofacial emphysema and pneumomediastinum, is presented. Possible pathogenetic mechanisms and treatment options are discussed.