Treatment Considerations Research Articles

Ethical Considerations in Substance Use Treatment for Youth: Assessing Clinical Practices and Policy Frameworks for Potential Harm.

The current conceptual review highlights considerations surrounding the potential for non-beneficence and undue coercion within the practices of psychologists and other clinicians providing substance use treatment for youth. The potential for nonbeneficence and undue coercion is assessed at three key stages of treatment for youth with substance use disorders (SUDs): the informed consent process, maintaining confidentiality, and treatment planning. We explore these concerns as they relate to the ethical principles of psychologists as outlined by the American Psychological Association (American Psychological Association [APA], 2017), as well as pertinent state and national legislative guidelines. The paper culminates in actionable recommendations to resolve these inconsistencies in practice and emphasizes opportunities for professionals at all career stages to engage in ethical policy initiatives. These endeavors aim to reduce potential for undue coercion and nonbeneficence from psychologists treating youth with substance use disorders and to elucidate beneficial treatment pathways for youth navigating substance use challenges.

What Radiographic and Spinopelvic Parameters do Spine Surgeons Consider in Decision-Making for Treatment of Degenerative Lumbar Spondylolisthesis?

Cross-sectional survey. Surgical treatment of degenerative lumbar spondylolisthesis is remarkably varied due to heterogeneity of clinical-radiological presentations. This study aimed to assess which spinopelvic radiological parameters were considered for decision-making. Survey distributed to International AO Spine members to analyze surgeons' considerations for treatment. Data collected includes demographics, training background, years of experience, and treatment decisions based on various radiographical findings, including segmental and global spinopelvic parameters. From 479 responses, the most frequently radiological parameter considered was slippage on dynamic X-rays (79.1%), followed by disc height (78.9%), global sagittal balance SVA (71.4%), and PI-LL mismatch (69.7%), while the least important was absolute spondylolisthesis on static lateral radiograph (22.8%). Fellowship-trained surgeons were likelier to use SVA (OR = 1.73, 95% CI = 1.02-2.99, P = 0.049), and disc height (2.13, 1.14-3.98, P < 0.05). There was no difference between orthopedics and neurosurgery in applying SVA and PI-LL mismatch. Surgeons from Asia Pacific emphasizes segmental lordosis (2.39, 1.11-5.15, P = 0.026) as from Latin America (2.55, 1.09-5.95, P = 0.030) and Middle East (4.33, 1.66-11.28, P = 0.003). However, surgeons from Latin America and Middle East also significant consider disc height (2.95, 1.07-8.15, P = 0.037) and (3.03, 1.04-8.83, P = 0.043), respectively. Additionally, the surgeons' age was associated with using angular motion on flexion-extension radiographs, and volume of treated cases yearly with consideration for disc height. Treatment of degenerative lumbar spondylolisthesis was influenced by slippage on dynamic radiographs, disc height, global alignment, and PI-LL mismatch. Surgeons' age and Region, fellowship-trained, and volume of treated cases were significantly associated to apply these radiological parameters.

Clinical experience and treatment considerations with vesicular monoamine transport 2 inhibitors

Abstract Vesicular monoamine transporter 2 inhibitors (VMAT2i) are currently Food and Drug Administration–approved for the treatment of Huntington disease chorea and tardive dyskinesia. Additionally, they are often used for other hyperkinetic movement disorders in clinical practice. Due to a lack of head-to-head clinical trials, management of VMAT2i in the clinical setting may be unclear and rely on the clinical experience of the practitioner. Due to the limited distribution model, which typically requires VMAT2i to be dispensed by specialty pharmacies, access and initiation of treatment may present as barriers. Patient cases allow for the exploration of switching between VMAT2i, alternative routes of administration, utilization in pediatric and off-label conditions, and how to successfully initiate and monitor a patient on VMAT2i therapy.

Management of pediatric thyroid carcinoma.

The incidence of thyroid carcinoma is increasing among children and adolescents, particularly in female individuals. Children and adolescents require special considerations in management as the molecular genetics of pediatric thyroid tumors are inherently different from their adult counterparts. The increased risk of malignancy, nodal metastases, and pulmonary metastases in pediatric patients warrants pediatric-specific management recommendations and pediatric-specific multidisciplinary teams. This article highlights the molecular origins of pediatric thyroid carcinoma and the implications of tumor genetics for the course of disease and treatment considerations. We highlight specific surgical considerations to optimize outcomes while minimizing lifelong risks of vocal paralysis and hypoparathyroidism. The landscape of treatment options is rapidly evolving with development of sophisticated molecular approaches to understand the genetic landscape, and this review features updated recommendations and systemic treatment options for the management of pediatric thyroid malignancy. Pediatric thyroid carcinoma is a lifelong burden and the treatment tailored to optimize outcomes minimizes long-term risks of treatments, surgery, radiation and targeted systemic therapies. Multidisciplinary teams that treat pediatric thyroid carcinoma should focus surgical experience and use the most updated guidelines and treatments available, particularly considering the landscape of molecular genetics in pediatric thyroid carcinoma.

A Consensus Statement on the Administration of Systemic Bevacizumab in Patients with Recurrent Respiratory Papillomatosis.

To provide detailed guidance on the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis (RRP) based on a detailed review of the scientific literature and a consensus of experts with real-world clinical experience. A bevacizumab consensus working group (N = 10) was composed of adult and pediatric otolaryngologists, adult and pediatric oncologists, and a representative from the RRP Foundation (RRPF), all with experience administering systemic bevacizumab in patients with RRP. After extensive review of the medical literature, a modified Delphi method-based survey series was utilized to establish consensus on the following key areas: clinical and patient characteristics ideal for treatment candidacy, patient perspective in treatment decisions, treatment access, initial dosing, monitoring, guidelines for tapering and discontinuation, and reintensifying therapy. Seventy-nine statements were identified across nine critical domains, and 45 reached consensus [clinical benefits of bevacizumab (3), patient and disease characteristics for treatment consideration (7), contraindications for treatment (3), shared decision-making (incorporating the patient perspective) (5), treatment access (3), initial dosing and administration (8), monitoring (7), tapering and discontinuation (6), and reintensification (3)]. This consensus statement provides the necessary guidance for clinicians to initiate systemic administration of bevacizumab and represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP. 5 Laryngoscope, 134:5041-5046, 2024.

Ischemic Stroke in Women: Understanding Sex-Specific Risk Factors, Treatment Considerations, and Outcomes

Ischemic stroke is a major cause of mortality and disability and has become a significant public health concern among women. Overall, women have more ischemic stroke events than men, in part due to their longer life span, and also suffer from more severe stroke-related disabilities compared to men. Women are also more likely than men to present with atypical non-focal neurological symptoms, potentially leading to delayed diagnosis and treatment. Female-specific risk factors, especially those related to pregnancy, are often under-recognized. A woman’s risk for ischemic stroke evolves throughout her lifespan, influenced by various factors including the age of menarche, pregnancy and its complications (such as parity, pre-eclampsia/eclampsia, and preterm delivery), postpartum challenges, oral contraceptive use, and menopause. Additionally, vascular risk factors like hypertension, diabetes, and atrial fibrillation are more prevalent among older women. Despite comparable treatment efficacies, women generally experience poorer outcomes after stroke. They also face higher rates of post-stroke depression, further complicating recovery. Although significant strides have been made in reducing the incidence of ischemic stroke, our understanding of the unique risks, underlying causes, and long-term consequences for women remains limited. While sex hormones may explain some differences, a lack of awareness regarding sex-related disparities can result in suboptimal care. This review aims to illuminate the unique risks and burdens of ischemic stroke faced by women, advocating for a more nuanced understanding to enhance prevention and treatment strategies.

Retreatment predictors after percutaneous balloon gangliolysis for trigeminal neuralgia

Percutaneous balloon ganglyolysis (PBG) for trigeminal neuralgia (TN) is an inexpensive and minimally invasive treatment modality that is effective and safe. While there are reports of its efficacy, there is still a lack of evidence of which patients are at a higher risk of treatment failures and needing retreatment. We performed a retrospective study at a major academic institution from 2012 to 2023, including TN patients who underwent PBG procedures to evaluate predictors of retreatment. Patients without imaging available from the PBG were excluded. Fifty-two patients who underwent 83 procedures in total were included in the analysis. All patients had typical TN and were primarily female (59.6%), with a median age of 61.5 years. Immediately after PBG, 42.3% had pain resolution, and 57.7% had improved but persistent pain. 30.8% underwent retreatment with PBG in a median of 32 months. From multiple factors assessed, TN disease duration ≤ 6 months and trigeminal nerve enhancement on pre-operative MRI were identified as significant retreatment predictors on univariate analysis. However, after performing logistic regression, only TN disease duration ≤ 6 months remained significant OR 3.99 (95% CI 1.59–10.0; p = 0.003). This was further confirmed in a Kaplan-Meier survival analysis, which showed that patients with TN duration ≤ 6 months require retreatment earlier (22 vs. 41 months; p = 0.01). Retreatment after PBG occurs roughly in a third of patients, and TN disease duration of ≤ 6 months is an important predictor in this study. Further studies should be performed to confirm these findings, which may impact treatment considerations in the future.

Ends of the spectrum best practices for early detection and multidisciplinary management of acromegaly.

Acromegaly is characterized by an insidious clinical presentation and delayed diagnosis. Longer delays are associated with more comorbidities which can persist after treatment of the growth hormone-secreting pituitary adenoma (GH-PA). Surgery is the primary therapy of GH-secreting PA, which can lead to durable remission. However, approximately 50% of patients require medical treatment postoperatively. Survival normalizes after achieving biochemical control. This mini-review will address ends of the spectrum challenges in acromegaly, including delayed diagnosis and management of the residual tumor and persistent comorbidities. We synthesize relevant literature and present a case of acromegaly that highlights the complexity of clinical decision-making in the diagnosis and treatment of persistent acromegaly. Despite improved biochemical assays, most patients with acromegaly are diagnosed on average five years after initial symptoms. A high index of suspicion does not rely exclusively on acral enlargement, but also a constellation of manifestations and comorbidities suggestive of acromegaly. Medical therapy is required in patients with persistent biochemical disease. Somatostatin receptor ligands are the cornerstone of medical treatment and can be used alone or in combination with dopamine agonists and growth hormone receptor antagonists. Improved options of medical treatment and careful consideration of comorbidities enables individualized patient management. Reoperation and radiation are considered for tumor progression despite medical therapy. In rare cases of resistant and aggressive tumors, neuro-oncology expertise is required. Increased awareness through education targeting the multifaceted clinical presentation of acromegaly shortens the time to diagnosis and treatment. Multidisciplinary management by specialists increases the likelihood of biochemical and tumor control.

Preface

As Editor-in-Chief of GenoMed Connect, it is my great pleasure to introduce the inaugural issue of this journal, dedicated to bridging the fields of genomics and medicine. Our vision for GenoMed Connect is to serve as a platform for the latest research that informs precision medicine and promotes integrative healthcare approaches. This inaugural issue features a diverse collection of seven articles, showcasing the journal's commitment to interdisciplinary research and its impact on advancing medical science. Each study addresses a unique aspect of genomics and medical research: 1. Evaluation of IL-12 Gene Expression in Coronary Artery Disease examines the role of IL-12 in atherosclerosis, shedding light on inflammatory pathways that may serve as therapeutic targets in coronary artery disease. 2. A Case Report on Epidermolytic Hyperkeratosis Type 1 introduces a novel mutation in the KRT1 gene, expanding the understanding of genetic dermatological conditions and offering insights into the molecular underpinnings of epidermolytic hyperkeratosis. 3. Identification of Prognostic Biomarkers in Uveal Melanoma explores tumor immune microenvironments, identifying genetic markers that could improve the prediction and treatment strategies for this rare but aggressive form of eye cancer. 4. HLA Class I and II Gene Diversity in North India provides an extensive genetic analysis that is valuable for transplantation immunology and population genetics, enhancing the knowledge of HLA variability and its implications in disease association. 5. Investigation of TLR and CD36 Expression in Coronary Artery Disease delves into the immune response mechanisms in coronary artery disease, examining the role of toll-like receptors and their potential as markers for disease progression. 6. Ethical Approaches in Reporting Secondary Findings from Exome Sequencing reviews current guidelines and ethical considerations, addressing challenges in reporting incidental findings and highlighting pathways for more responsible genomic data sharing. 7. The Role of Microbes in Endocrine Health presents an intriguing review on microbial endocrinology, exploring the influence of the gut microbiome on hormone regulation and its implications for metabolic health. These articles embody the interdisciplinary nature of GenoMed Connect, contributing to a deeper understanding of genomics in disease diagnosis, treatment, and ethical considerations. I extend my gratitude to our dedicated editorial board, the reviewers, and the team at Scifiniti for their hard work in bringing this issue to life. I look forward to witnessing the journal’s growth as it continues to foster collaboration and drive innovation in genomic medicine. I hope that the research presented in this issue inspires readers and advances our collective efforts to improve healthcare through genomic insights.

Exploring Sex, Gender, and Gender-Related Sociocultural Factors in Clinical Decision-Making for Older Adults Using a Prescribing Cascade Vignette: A Transnational Qualitative Study.

Despite growing awareness of sex differences in inappropriate prescribing among older adults, including the initiation of problematic prescribing cascades, the impact of gender bias remains largely unexplored. We explored how a patient's sex and gender-related sociocultural factors influence physicians' prescribing decisions, potentially leading to prescribing cascades in older adults. A secondary objective was to explore whether and how physician sex affected prescribing decisions for female and male patients. Physicians in Canada and Italy were presented with a clinical vignette describing an older male or female patient on amlodipine presenting with peripheral edema. Physicians were interviewed using the 'think-aloud' method to describe their treatment considerations. Thematic multi-site analysis was used to analyze the data. Of 30 physicians, only two considered prescribing a diuretic for an older female patient. Most physicians identified amlodipine as the cause of the edema and adjusted or substituted the medication, often making these treatment decisions without considering sex- and gender-related sociocultural factors. When prompted, physicians acknowledged the relevance of these factors, but their responses varied. Some adapted their treatment plans, noting the challenges of managing edema, particularly for female patients, whereas others did not incorporate these considerations. Interestingly, some physicians adjusted their plans based on gender-related factors yet still stated that gender did not influence their treatment decisions. No variations in treatment decisions based on physician sex were observed. The study reveals a gap between physicians' recognition of gender-related sociocultural factors and their consistent integration into clinical decision-making, highlighting the need for more nuanced approaches in prescribing practices.

Quantifying menorrhagia and overview of nonsurgical management of heavy menstrual bleeding.

Heavy menstrual bleeding (HMB) is a common problem, presenting in 1 in 5 females. The quantification of menstrual blood loss and the subsequent treatment of HMB are both nuanced tasks that require the physician to consider the patient perspective. The individualization of care and transition to methods that fit each individual patient are critical to building a successful relationship with the patient to facilitate follow-up care and evaluation of response to treatment. In this review we outline various methods of quantification of menstrual blood loss, including considerations of accuracy and practicality. These methods, all of which have the potential for clinical benefit, vary from pictorial assessment charts to the gold standard alkaline hematin method to asking the patient about their average amount of blood loss and how it affects their quality of life. Next, we outline nonsurgical treatments for HMB, including hormonal and nonhormonal options, and consider the potential for success, as well as treatment considerations and contraindications. Overall, options for the evaluation and nonsurgical management of menstrual blood loss and HMB are presented along with quality-of-life considerations.

Current Status and Considerations on Endoscopic Diagnosis and Treatment of Subepithelial Microlesions in the Digestive Tract

The detection rate of subepithelial lesions in the digestive tract, especially microlesions (≤ 1 cm in diameter), has significantly increased. Historically, periodic follow-up or surgical resection has been recommended by scholars. Due to the potential risk of malignancy, regular follow-up carries certain risks, while surgical resection, though effective, is highly invasive with a high risk of complications. With the rapid development of endoscopic techniques, more and more subepithelial lesions in the digestive tract have been successfully treated through endoscopic submucosal dissection and endoscopic full-thickness resection. However, these methods require a high level of skill and are associated with significant costs for surgical instruments and materials. Therefore, it is worth exploring whether a simpler and more efficient treatment can transition patients from observation to proactive treatment. A modified technique combining snare, long transparency cap, and Argon Plasma Coagulation under endoscopy has advantages over traditional methods, such as being simpler to perform, less prone to complications, and more cost-effective. This article reviews the current status and considerations of endoscopic treatment for subepithelial lesions in the digestive tract.

Global Change in Psychotherapy: Influences of Current Social Change on Mental Health and Therapy

Global change affects both individual life situations and social coexistence in a variety of ways. However, the effects of social events on mental illness and psychotherapy are only recorded and included in psychotherapy research in individual areas. The aim of this study is to explore current problems and concerns of patients in Germany on the basis of practical experience reports, to collect possible social causes and to bundle considerations for therapeutic treatment. To this end, psychotherapists (n=10) and psychotherapy patients (n=12) were interviewed in qualitative interviews and these were analyzed using grounded theory. After evaluating the collected perspectives, five main effects of current social events and the consequences of globalization were identified. From the perspectives of psychotherapists and patients, these include increasing anxiety about the future, decreasing social inclusion, increased questions about goals and identity as a concern for psychotherapy, increased psychological stress as a result of political divide and an increased demand for diversity-sensitive psychotherapy. In addition to expanding the scope of action, therapeutic approaches primarily include providing contact, guidance, orientation, emotional support and bonding experiences. The inclusion of knowledge from psychotherapists and patients as well as findings from social science can be helpful for identifying current problems and developing new therapeutic approaches or bundling, linking, and effectively using existing ones.

The Analysis Study of Diagnosis and Management of Epitaxis :A Comprehensive Systematic Review

Background: Epistaxis, or nasal haemorrhage, is a common and potentially serious clinical presentation that can range from a minor inconvenience to a life-threatening emergency. This systematic review aims to provide a comprehensive analysis of the diagnosis and management of epistaxis, emphasizing the interplay between epidemiological factors, anatomical considerations, and clinical risk assessment. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2014 to 2024. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 2,172 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: Epistaxis is a multifactorial condition influenced by local and systemic factors, including comorbidities, medication use, and blood markers. Comprehensive treatment, such as effective initial management, bleeding point identification, and control of hypertension and anemia, is essential for improving outcomes. NOACs offer promising alternatives but require careful treatment consideration.

Thoracic aneurysmal bone cyst secondary to osteoblastoma: unique surgical management. Illustrative case.

Aneurysmal bone cysts (ABCs) are rare, benign, yet locally aggressive lesions that contain blood-filled channels that rarely occur in the thoracic spine of adults. The literature on the treatment of spinal ABCs is sparse, but the consensus is to achieve gross-total resection (GTR) due to these lesions being locally aggressive and to prevent recurrence. This report describes a 35-year-old female admitted with back pain and right T5 dermatome radiculopathy without any inciting events. Magnetic resonance imaging revealed a 3.0 × 4.3 × 4.0-cm solid, enhancing, multicystic lesion with multiple fluid levels centered in the right posteromedial chest wall, involving the right fifth rib and costovertebral junction. Because of the high suspicion for an ABC, later found to be secondary to an osteoblastoma, surgical intervention was planned via preoperative embolization and T4-6 fusion with right T5 laminectomy and costotransversectomy to obtain GTR. This case of an ABC secondary to osteoblastoma of the spine showcases a strategy for unique surgical management, given the limited information on treatment considerations for secondary ABCs. https://thejns.org/doi/10.3171/CASE24471.

Paradoxical Deterioration During Treatment of Tuberculous Meningitis Responded to Infliximab But Not to Steroids.

Patients with tuberculous meningitis may experience a paradoxical deterioration in spite of correct antituberculosis treatment.The paradoxical deterioration may have a severe clinical presentation, requiring high vigilance and consideration of treatment escalation.Here we report that off-label administration of tumour necrosis factor-alpha blocker infliximab induced a significant clinical and radiological improvement in a severe case of paradoxical deterioration in a patient with tuberculous meningitis, suggesting its potential as a treatment when standard therapies fail.

The emotional well-being and mental health of Hispanic immigrants in the United States: understanding the impact of traumatic experiences and coping styles

ABSTRACT This cross-sectional study examined factors that impact the emotional well-being of Hispanic immigrants. This study considered the experience of stigma, acculturative stress, and traumatic events on the emotional well-being of Hispanic immigrants, while exploring various coping strategies that are employed. Data from 198 Hispanic immigrants in the United States was collected from an online survey, and a multiple linear regression was used with several predictor groups. Results indicated statistical significance between traumatic experiences, acculturative stress, positive/negative religious coping, and avoidant coping styles on the emotional well-being of Hispanic immigrants. These findings hold significance for social workers and offers considerations for assessment, treatment, and advocacy.

The development of a C5.0 machine learning model in a limited data set to predict early mortality in patients with ARDS undergoing an initial session of prone positioning

BackgroundAcute Respiratory Distress Syndrome (ARDS) has a high morbidity and mortality. One therapy that can decrease mortality is ventilation in the prone position (PP). Patients undergoing PP are amongst the sickest, and there is a need for early identification of patients at particularly high risk of death. These patients may benefit from an in-depth review of treatment or consideration of rescue therapies. We report the development of a machine learning model trained to predict early mortality in patients undergoing prone positioning as part of the management of their ARDS.MethodsProspectively collected clinical data were analysed retrospectively from a single tertiary ICU. The records of patients who underwent an initial session of prone positioning whilst receiving invasive mechanical ventilation were identified (n = 131). The decision to perform prone positioning was based on the criteria in the PROSEVA study. A C5.0 classifier algorithm with adaptive boosting was trained on data gathered before, during, and after initial proning. Data was split between training (85% of data) and testing (15% of data). Hyperparameter tuning was achieved through a grid-search using a maximal entropy configuration. Predictions for 7-day mortality after initial proning session were made on the training and testing data.ResultsThe model demonstrated good performance in predicting 7-day mortality (AUROC: 0.89 training, 0.78 testing). Seven variables were used for prediction. Sensitivity was 0.80 and specificity was 0.67 on the testing data set. Patients predicted to survive had 13.3% mortality, while those predicted to die had 66.67% mortality. Among patients in whom the model predicted patient would survive to day 7 based on their response, mortality at day 7 was 13.3%. Conversely, if the model predicted the patient would not survive to day 7, mortality was 66.67%.ConclusionsThis proof-of-concept study shows that with a limited data set, a C5.0 classifier can predict 7-day mortality from a number of variables, including the response to initial proning, and identify a cohort at significantly higher risk of death. This can help identify patients failing conventional therapies who may benefit from a thorough review of their management, including consideration of rescue treatments, such as extracorporeal membrane oxygenation.This study shows the potential of a machine learning model to identify ARDS patients at high risk of early mortality following PP. This information can guide clinicians in tailoring treatment strategies and considering rescue therapies. Further validation in larger cohorts is needed.

Immunogenicity of Therapeutic Antibodies Used for Inflammatory Bowel Disease: Treatment and Clinical Considerations.

The introduction of tumor necrosis factor inhibitors has led to a paradigm shift in the management of inflammatory bowel disease (IBD). The subsequent introduction of both anti-integrins and cytokine blockers has since expanded the biologic armamentarium. However, immunogenicity, defined as the production of anti-drug antibodies (ADAs) to the prescribed biopharmaceutical, means a significant fraction of patients exposed to biologic agents will experience a secondary loss of response to one or more of the drugs. In clinical settings, immunogenicity may be caused by several factors, both patient related (e.g., underlying chronic disease, systemic immune burden, including previous biologic therapy failure, and [epi]genetic background) and treatment related (e.g., dose and administration regimens, drug physical structure, photostability, temperature, and agitation). Here, we outline these elements in detail to enhance biopharmaceutical delivery and therapy for patients with IBD. Moreover, concurrent immunomodulator medication may reduce the risks of ADA generation, especially when using the chimeric drug infliximab. Summarizing the latest developments and knowledge in the field, this review aims to provide strategies to prevent ADA production and information on managing non-responsiveness or loss of response to biologics. Better understanding of the molecular mechanisms underlying the formation of ADAs and the critical factors influencing the immunogenicity of biopharmaceuticals may lead to improved health outcomes in the IBD community that may benefit both the individual patient and society through lower healthcare expenses.

Facial high-pressure injection injury with air in a child

BackgroundHigh-pressure injection injuries are rare injuries and are frequently underestimated due to the limited external damage. Because of their association with occupational activities, these injuries are predominantly seen in hands. Facial involvement in such traumas is extremely rare. The difference in facial anatomy compared to the extremities demands careful consideration of both associated complications and treatment options.CaseA 6-year-old girl with no significant medical history was presented to the Emergency Department with a high-pressure injection injury to her right eye with a high-pressure cleaner. This resulted in injection of air at a pressure of 8 bar into the eye. She developed significant subcutaneous emphysema in the facial and neck regions. Additionally, intraorbital and intracranial emphysema were identified without any fractures. Treatment consisted of inpatient observation and antibiotic treatment. The patient was discharged after one day of observation for continued antibiotic treatment at home. Two weeks later, the patient had no residual symptoms and there were no signs of secondary infection.ConclusionHigh-pressure injection injuries to the face are rare and demand a different approach compared to the most common high-pressure injection injuries to the extremities. The nature of the injected material is paramount in choosing the appropriate treatment. This case illustrates that a high-pressure injection injury with air in the facial region, leading to extensive emphysema, can be managed conservatively with antibiotic therapy and inpatient observation.