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PubMedDate not supplied

Subcutaneous cervicofacial emphysema and pneumo-mediastinum: a rare complication after a crown preparation.

Subcutaneous cervicofacial emphysema and pneumo-mediastinum are relatively rare complications from different dental procedures (including oral surgery and restorative treatment). Many cases go unrecognized or are misdiagnosed. While the majority of cases resolve spontaneously, some can lead to life-threatening complications that require emergency intervention. This article presents a case report of subcutaneous and mediastinal emphysema following a routine restorative dental procedure. The differential diagnosis and management of this condition is discussed.

Adult↗
PubMed1986

Pneumomediastinum and subcutaneous cervical emphysema during third molar extraction under general anesthesia.

A case of pneumomediastinum and subcutaneous cervical emphysema during the extraction of third molars under general anesthesia has been presented. The most likely cause was pulmonary barotrauma secondary to a faulty expiratory valve. This emphasizes the need for the proper preoperative check of all anesthetic equipment. Although pneumomediastinum and subcutaneous cervical emphysema are usually self-limiting conditions with rapid recovery, the patient must undergo close observation for the possible development of serious complications.

Adult↗
PubMed1988

Subcutaneous facial emphysema secondary to use of the Cavi-Jet.

A case of subcutaneous facial emphysema secondary to use of the Cavi-Jet air polishing system is reported. Air pressure of the Cavi-Jet may exceed that of other dental instruments such as the air/water syringe or air turbine handpiece. Inadvertent angulation of the nozzle tip into a severe periodontal pocket precipitated this condition, which resolved with no serious sequelae. No treatment other than prophylactic antibiotics was prescribed.

Dental Prophylaxis↗
PubMed2003

[Spontaneous cervical emphysema: a case report].

Spontaneous cervical subcutaneous emphysema, without any aetiology found in the clinical history, is far less common than subcutaneous cervical emphysema following trauma, surgery, or infectious cervical processes. In this recent case report, the authors describe a young woman who developed a cervical subcutaneous emphysema. No responsible factor had been found. Radiological investigations revealed a pneumomediastinum, which is an uncommon but a serious complication of cervical emphysema. The CT-scan highlighted a rupture of the crico-thyroid membrane, from which the air had followed the fascial planes up to the neck and the mediastinum. The authors describe the treatment and clinical course. They put forward an embryological hypothesis regarding the spontaneous crico-thyroid membrane rupture. A congenital fragility of this area could exist which could explain its breach. The pathogenesis and management of spontaneous cervical emphysema are discussed in the light of diverses articles about this subject. The radiological or surgical explorations which may be used in this aetiological diagnosis and treatment are given.

Adult↗
PubMed1985

[Unusual cutaneous emphysema in a newborn infant following bilateral pneumothorax].

We report a patient with subcutaneous emphysema after a bilateral pneumothorax of gigantic extent: Subcutaneous emphysema extended over the chest, neck, axilla and both arms. The scalp was severed from the galea by an enormous air-cushion. Theories about the pathogenetic mechanisms are discussed. Therapy consisted of treatment of the underlying condition e. g. thoracocentesis with pleural drainage and artificial ventilation. The subcutaneous emphysema resolved without further therapeutic measures; only the subgaleal air was removed by aspiration.

Emphysema↗
PubMed2006

Maintenance of subcutaneous cavities with CO2.

UNLABELLED: Since mechanical retractors in endoscopic plastic surgery cause certain drawbacks, we developed a model in dogs, which, by insufflating CO2 into a subcutaneous cavity, we were able to maintain. We evaluated the magnitude of subcutaneous emphysema and absorption of CO2 by insufflating different pressures and the efficacy of external pressure on the skin with the purpose of limiting the subcutaneous emphysema. Sixteen dogs were divided in 3 groups, A, B, and C. We controlled the pulmonary function by using a volume-cycle ventilator. In all groups, we maintained a subcutaneous cavity by insufflating CO2. Groups A and C were insufflated at 15 mm Hg; group B, at 8 mm Hg. We placed circumferential Esmarch bandages on the thorax of groups B and C to delimit superiorly and inferiorly the surgical area. Arterial blood gas analyses (ABGA) were taken from the femoral artery 60 minutes after intubation, 60 minutes after Esmarch bandage was placed and at the end of the CO2 insufflation. Statistically, results were analyzed by Wilcoxon test. P < 0.05 was considered statistically significant. Group A showed extensive subcutaneous emphysema. Two dogs died. The systemic increase of the CO2 showed a median of 9.6 mm Hg (P < 0.05). In Group B, Esmarch bandages caused increase in CO2, with a median of 1.65 mm Hg (P < 0.028). None of these dogs showed subcutaneous emphysema during the insufflation after CO2 insufflation pressure augmented with a median of 3.7 mm Hg (P < 0.028). In Group C, chest restriction increased CO2 median of 6.1 mm Hg (P < 0.043), and subcutaneous emphysema shown was less extensive than group A. The CO2 increased after insufflation a median of 16 mm Hg (P < 0.043). CONCLUSIONS: Subcutaneous cavities can be maintained open with CO2 insufflation at 8 mm Hg, limiting perfectly the surgical area; as done with Esmarch bandages, it reduces CO2 absorption and makes this procedure safe.

Animals↗
PubMed1999

Retroperitoneoscopic surgery is not associated with increased carbon dioxide absorption.

PURPOSE: Previous studies have suggested that retroperitoneal laparoscopy is associated with greater carbon dioxide absorption and related postoperative morbidity, such as subcutaneous emphysema and pneumothorax. We prospectively compared the effects of carbon dioxide absorption during transperitoneal and retroperitoneal laparoscopic renal and adrenal surgery at our institution. MATERIALS AND METHODS: Data were collected prospectively on 51 patients who underwent laparoscopic renal (26) or adrenal (25) surgery via the transperitoneal (18) or retroperitoneal (33) approach from September 1997 to February 1998. RESULTS: There was no significant difference in carbon dioxide elimination in patients who underwent transperitoneal laparoscopy compared to retroperitoneoscopy at any interval. Subcutaneous emphysema occurred in 12.5% of the transperitoneal and 45% of the retroperitoneal group (p = 0.09). Patients with subcutaneous emphysema had greater carbon dioxide elimination during the first 2.5 hours of insufflation compared to those without subcutaneous emphysema and, thereafter, carbon dioxide elimination decreased to baseline. CONCLUSIONS: In contrast to previous reports our prospective nonrandomized study suggests that retroperitoneoscopy is not associated with greater carbon dioxide absorption compared to transperitoneal laparoscopy. Patients with subcutaneous emphysema exhibited only transient increases in carbon dioxide absorption above control levels.

Absorption↗
PubMed2004

Iatrogenic pneumomediastinum and facial emphysema after endodontic treatment.

Subcutaneous emphysema is well known, but diffusion of gas into the mediastinum is not so common, particularly if it is caused by treatment of a root canal without apparent osseous fenestration or mucoperiostal lesions. We report a case of iatrogenic pneumomediastinum and facial emphysema after endodontic treatment. The diagnosis was confirmed by computed tomography, and the patient recovered after treatment with intravenous antibiotics and analgesia.

Adult↗
PubMedDate not supplied

Orbital emphysema and diplopia following thoracotomy.

PURPOSE: To describe the clinical and radiological findings in a patient with diplopia and orbital emphysema following thoracotomy. METHODS: Reported is a 71-year-old woman who presented with diplopia several days following thoracotomy. RESULTS: Physical examination revealed diffuse subcutaneous emphysema and a right hypertropia. Head computed tomography revealed facial and palpebral subcutaneous emphysema extending into the infratemporal fossa and orbits bilaterally. A chest tube was replaced and her diplopia resolved. CONCLUSIONS: Subcutaneous emphysema can lead to diplopia and orbital emphysema in the absence of orbital trauma. Contrary to previously suggested mechanisms of orbital emphysema associated with subcutaneous emphysema, computed tomography imaging suggested that air entry into the orbit in this case was through the inferior orbital fissure.

Aged↗
PubMed1995

Carbon dioxide absorption during laparoscopic pelvic operation.

BACKGROUND: Several factors may influence the degree of carbon dioxide (CO2) absorption during laparoscopy. Hypercapnia as a result of excessive CO2 absorption may have adverse clinical effects. STUDY DESIGN: To identify factors associated with increased CO2 absorption, we retrospectively calculated the CO2 elimination in 65 adult patients who underwent operative pelvic laparoscopy. Increases in CO2 elimination were assumed to be indicative of CO2 absorption. The most commonly performed procedures were bladder neck suspension and pelvic lymphadenectomy. The median insufflation time was 165 minutes. An extraperitoneal approach was taken in 32 percent of the patients. RESULTS: Of patients evaluated with postoperative roentgenograms of the chest, 35 percent had subcutaneous emphysema and 9 percent had pneumomediastinum with or without pneumothorax. Multiple factorial analysis of the variance revealed that the extraperitoneal approach, development of subcutaneous emphysema, and increased duration of insufflation were independently associated with a greater increase in peak CO2 elimination. Insufflation time and subcutaneous emphysema had stronger effects in the extraperitoneal group. CONCLUSIONS: The risk factors for hypercapnia can be identified. Careful consideration of the patient's ability to tolerate hypercapnia should be made when planning extraperitoneal laparoscopy, especially if the procedure is likely to be prolonged. The clinical development of subcutaneous emphysema should alert the surgeon to the possibility of subsequent hypercapnia.

Absorption↗
PubMed1994

Measles--an experience in Sandakan Hospital, Sabah, 1990.

A descriptive study of 143 cases of clinically diagnosed measles in patients under the age of 12 years admitted to the Duchess of Kent Hospital, Sandakan, Sabah, during the year 1990 was carried out. The median age of the patients was one year and 13.3% of the cases were between the ages of 6 and 9 months. The male to female ratio was 1.3:1. The majority of the cases (85.3%) were not immunised against measles while 60.0% of the cases were malnourished. Most of the cases (86.0%) had at least one complication with 32.9% of the cases having more than one complications. The main complications were pneumonia (74.1%) and diarrhea (38.5%). Other complications were convulsions, otitis media and corneal ulceration/scarring. A case of pneumonia with mediastinal emphysema and subcutaneous emphysema was noted. The case fatality rate was 1.4% while blindness was the long term morbidity in 1.4% of the cases. Measles remains an important cause of morbidity in children in Sabah.

Borneo↗
PubMed1995

Sucking wounds of the limbs.

Subcutaneous emphysema affecting a limb in isolation is rare. Three cases of subcutaneous emphysema caused by a sucking wound of the limb are presented. Differentiation from infection with a gas-forming organism is imperative. This distinction can be made if a number of factors are taken into consideration. These include, concise knowledge of the history and mechanism of injury, and in particular, full appreciation of the amount of energy transfer causing the wound, the macroscopic appearance of the wound, the presence or absence of systemic symptoms, the time from injury to the development of subcutaneous emphysema, and the radiographic appearance of the soft tissues.

Adult↗
PubMed2000

[Hyoid fracture and traumatic subcutaneous cervical emphysema from an attempted hanging. Apropos a case].

We describe a patient with a history of psychiatric disorder who was brought to our hospital after attempted suicide by hanging. Severe subcutaneous facial, palpebral and cervical emphysema was present, with dysphonia, dysphagia and slight respiratory difficulty. Fiberoptic bronchoscopy revealed upper airway obstruction due to edema in an intact airway. Successive CAT scans gave evidence of hyoid fracture and laryngocele, in addition to the corresponding emphysema of the subcutaneous area and pneumomediastinum. Given the persistence of dysphagia, we ordered esophageal tests, which showed functional alteration of the upper esophageal sphincter. Suprasternal cervicotomy to drain the pneumomediastinum and laryngeal microsurgery to treat the laryngocele resolved the problem.

Alcoholism↗
PubMed1996

Acute ventilatory complications during laparoscopic upper abdominal surgery.

PURPOSE: This article examines and summarizes the published reports dealing with subcutaneous emphysema, pneumothorax and carbon dioxide (CO2) embolism during laparoscopic upper abdominal surgery. The purpose is to describe the expected clinical picture, the differential diagnosis and the management of these complications. SOURCE: The information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth and Can J Anaesth. PRINCIPAL FINDINGS: An abrupt increase in PETCO2 is the first sign of subcutaneous emphysema and of pneumothorax. Desaturation and increased airway pressure occur with pneumothorax, but not with subcutaneous emphysema alone. Desaturation and increased airway pressure also occur with bronchial intubation. The preliminary diagnosis is made by verifying the position of the tube, examination of the patient for swelling and crepitus and auscultation for air entry. Chest radiography and paracentesis confirm the diagnosis of pneumothorax, which frequently occurs with subcutaneous emphysema but is rarely of the tension type. Pulmonary embolism due to CO2 during LUAS has not been reported, but the available data suggest that small, haemodynamically inconsequential CO2 embolism occurs without change in PETCO2. Massive embolism is possible and will markedly decrease PETCO2, arterial O2 saturation (SpO2) and blood pressure. CONCLUSION: The immediate recognition of the three complications requires continuous monitoring of PETCO2, arterial saturation, airway pressure, and an index of pulmonary compliance.

Abdomen↗
PubMed1976

A comparison of subcutaneous and preperitoneal emphysema arising from gynecologic laparoscopic procedures.

Out of 1,300 cases of gynecologic laparoscopic procedures reviewed, three incidences of preperitoneal emphysema and several incidences of subcutaneous emphysema were noted. There were a few significant differences in the diagnosis and management of these two types of emphysema. In the medical literature reviewed by the author, preperitoneal emphysema has not been discussed while subcutaneous emphysema has received quite a lot of attention. Preperitoneal emphysema is defined as a collection of air or other gas which occurs in the tissue spaces between the abdominal fascia and the ventral peritoneum.

Adult↗