Successful treatment of a rare subcutaneous emphysema after a blow-out fracture surgery using needle aspiration:A case report

BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.

With two episodes of right retromandibular angle subcutaneous emphysema during right upper molar crown preparation:A case report

BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.

Life-threatening delayed mediastinal and subcutaneous emphysema after general anesthesia in a rheumatoid arthritis patient: a case report

Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.

Pneumomediastinum and subcutaneous emphysema secondary to dental extraction:Two case reports

BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive.However,high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum,which is a serious iatrogenic complication.CASE SUMMARY We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction.The first case involved a 34-year-old man who complained of swelling of the face,mild chest tightness,and chest pain after dental extraction.Computed tomography(CT)scan showed a large amount of gas in the neck,chest wall,and mediastinum.The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction.CT showed a large amount of gas collected in the neck and mediastinum.Both of them used high-speed turbine splitting during dental extraction.CONCLUSION High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema.Dentists should carefully operate to avoid emphysema.If emphysema occurs,CT can be used to improve the diagnosis.The patient should be informed,and the complications dealt with carefully.

Subcutaneous Emphysema Associated with Pneumomediastinum and Complicated Pneumopericardium in a 14-Month-Old Infant

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Traumatic subcutaneous emphysema of the hand/forearm: A case report

Subcutaneous emphysema is commonly associated with infection caused by gas-producing organisms.In this case report,we describe a rare instance of traumatic subcutaneous emphysema of the hand and forearm caused by a puncture injury to the first web space of the hand.Our objective is to increase awareness of the potential for seemingly minor trauma to cause entrapment of significant air in subcutaneous tissues,thereby decreasing the likelihood that a clinically benign-appearing patient will be started down an unnecessarily aggressive treatment pathway.A 16-year-old,otherwise healthy white female,presented to the pediatric emergency room with an impressive amount of subcutaneous emphysema that developed over a 12-h period after sustaining an accidental laceration to the first web space of her right hand.She appeared nontoxic and had a clinically benign presentation.A comprehensive work-up was performed.She was splinted by the orthopedic surgery resident on call,and was admitted to the Pediatric Intensive Care Unit for overnight monitoring.She received tetanus vaccination and broad-spectrum antibiotics.The patient was discharged 2 days after admittance,with a splint applied to her right hand and forearm.She undertook home-based physical and occupational therapy.She had a pain-free range-of-motion in the right wrist,elbow and shoulder.The swelling in the right hand subsided completely.Although initially alarming,traumatic subcutaneous emphysema in an otherwise healthy patient from minor wounds(as featured in this case)does not necessarily mean one ought to proceed down an aggressive treatment algorithm.Careful evaluation of the patient's history,clinical examination findings,and determination of the Laboratory Risk Indicator for Necrotizing Fasciitis score can help guide physicians in the management of traumatic subcutaneous emphysema and potentially avoid unnecessary and costly interventions.

Air leaks in COVID-19

Coronavirus disease 2019(COVID-19)continues to create havoc and may present with myriad complications involving many organ systems.However,the respiratory system bears the maximum brunt of the disease and continues to be most commonly affected.There is a high incidence of air leaks in patients with COVID-19,leading to acute worsening of clinical condition.The air leaks may develop independently of the severity of disease or positive pressure ventilation and even in the absence of any traditional risk factors like smoking and underlying lung disease.The exact pathophysiology of air leaks with COVID-19 remains unclear,but multiple factors may play a role in their development.A significant proportion of air leaks may be asymptomatic;hence,a high index of suspicion should be exercised for enabling early diagnosis to prevent further deterioration as it is associated with high morbidity and mortality.These air leaks may even develop weeks to months after the disease onset,leading to acute deterioration in the post-COVID period.Conservative management with close monitoring may suffice for many patients but most of the patients with pneumothorax may require intercostal drainage with only a few requiring surgical interventions for persistent air leaks.

Pneumomediastinum Secondary to Foreign Body Aspiration： Clinical Features and Treatment Explorement in 39 Pediatric Patients

Background：Pneumomediastinum （PM） secondary to foreign body aspiration （FBA） is rare in children.Although it is mainly benign,some cases may be fatal.Due to the rare nature of this clinical entity,proper assessment and management have been poorly studied so far.Here,we characterized the presentation and management of this clinical entity and provided an evaluation system for the management.Methods：We retrospectively reviewed children with PM secondary to FBA,who were treated in Beijing Children＇s Hospital from January 2010 to December 2015.All patients were stratified according to the degree of dyspnea on admission,and interventions were given accordingly.Bronchoscopic removals of airway foreign bodies （FBs） were performed on all patients.For patients in acute respiratory distress,emergent air evacuation and/or resuscitations were performed first.Admission data,interventions,and clinical outcomes were recorded.Results：A total of 39 patients were included in this study.The clinical severity was divided into three grades （Grades Ⅰ,Ⅱ,and Ⅲ） according to the degree of dyspnea.Thirty-one patients were in Grade Ⅰ dyspnea,and they simply underwent bronchoscopic FBs removals.PM resolved spontaneously and all patients recovered uneventfully.Six patients were in Grade Ⅱ dyspnea,and emergent drainage preceded rigid bronchoscopy.They all recovered uneventfully under close observation.Two exhausted patients were in Grade Ⅲ dyspnea.They died from large PM and bilateral pneumothorax,respectively,despite of aggressive interventions in our hospital.Conclusions：PM secondary to FBA could be life-threatening in some patients.The degree of dyspnea should be evaluated immediately,and patients in different dyspnea should be treated accordingly.For patients in Grade Ⅰ dyspnea,simple bronchoscopic FBs removals could promise a good outcome.For patients in Grade Ⅱ dyspnea,emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become exhausted.