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Iatrogenic subcutaneous cervicofacial and mediastinal emphysema.

Subcutaneous emphysema of the head, neck and mediastinum occurs with a variety of disease processes. Most cases involve the passive escape of air from the aerodigestive tract into subcutaneous tissues. The many causes include head and neck surgical procedures, tracheal and esophageal trauma, intraoral trauma, foreign bodies and neoplasms of the aerodigestive tract, and pulmonary barotrauma from mechanical ventilation or in patients with pulmonary disorders. Subcutaneous emphysema secondary to active injection of air has recently been reported following certain dental procedures. An interesting case of diffuse cervicofacial and mediastinal emphysema following a difficult extraction of an infected lower molar tooth with a high-pressure air drill is presented. The patient required airway observation and high-dose antibiotic therapy. Early recognition of this unique problem is essential in preventing such life-threatening complications as airway obstruction, mediastinitis, deep neck infection, and cardiac failure. Diagnostic and therapeutic recommendations are included.

Humans↗

Spontaneous cervical and mediastinal emphysema.

Subcutaneous cervical emphysema often appears as a result of surgery or trauma. However, when it occurs spontaneously, the patient may present with clinically impressive and dramatic features. The etiology is related to the rupture of terminal alveoli and dissection of air along the pulmonary vasculature. Exercise may contribute to the process by increases in intrathoracic pressure. Six cases of spontaneous cervical emphysema, all related to SCUBA diving training at a Naval facility, were recently seen at our institution. Proper management entails having a high index of suspicion for diagnosis, and then being able to identify potentially life-threatening complications.

Adult↗

A case of spontaneous cervical and mediastinal emphysema.

Subcutaneous cervical and mediastinal emphysema usually can occurs as a result of surgery or trauma. Spontaneous cervical subcutaneous emphysema and pneumomediastinum, occurring in the absence of previous disorders or provocating factors, is very rare. The following case report of spontaneous cervical and mediastinal emphysema is assumed to be the first of its kind in Korea. The patient has been followed up for three years without recurrence or sequelae.

Adolescent↗