Subcutaneous emphysema is the local tissue swelling caused by the gas entering the subcutaneous tissue through the tissue gap. Although subcutaneous emphysema is usually a nonfatal and self-limited disease, in severe cases, the gas may spread to the neck, mediastinum and chest, resulting in mediastinal emphysema and other serious complications. This article reviews the etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis of subcutaneous emphysema related to dental therapy,and operations that may cause subcutaneous emphysema in stomatology department,as well as the treatment and prognosis of subcutaneous emphysema, with a view to providing some references for dentists.
Humans ; Diagnosis, Differential ; Mediastinal Emphysema/pathology* ; Subcutaneous Emphysema/therapy* ; Neck/pathology* ; Face

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.
Humans ; Child ; Female ; Adolescent ; Forearm ; Subcutaneous Emphysema/diagnosis* ; Upper Extremity ; Anti-Bacterial Agents/therapeutic use* ; Wounds, Penetrating/surgery*

Traumatic subcutaneous emphysema, which is the infiltration of air into subcutaneous tissues due to trauma, is caused by various factors such as chest and/or abdominal trauma, facial fractures, and barotrauma caused by mechanical ventilation. In this case report, a 32-year-old woman developed traumatic subcutaneous emphysema after undergoing abdominal liposuction at a local clinic. She was subsequently admitted to Busan Paik Hospital, and with early diagnosis and conservative treatment, she was discharged on the seventh day of hospitalization with no complications. However, because traumatic subcutaneous emphysema may accompany other injuries for various reasons, radiological examination and various tests should be performed to prevent serious complications and sequelae.
Adult ; Barotrauma ; Busan ; Early Diagnosis ; Female ; Hospitalization ; Humans ; Lipectomy ; Respiration, Artificial ; Subcutaneous Emphysema ; Subcutaneous Tissue ; Thorax

Iatrogenic postintubation tracheal injury is a rare but potentially fatal complication associated with anesthesia. However, as signs of tracheal injury including subcutaneous emphysema, pneumomediastinum, pneumothorax, and respiratory distress may also be related to surgical technique, diagnosis may be confused and treatment of tracheal injury can be delayed. We report a case of postintubation tracheal laceration, whose diagnosis was delayed because of symptoms were confused with subcutaneous emphysema after septorhinoplasty including osteotomy. As symptoms deteriorated in spite of conventional management, patient underwent evaluation to determine other causes and eventually postintubation tracheal injury was detected. Therefore, even if there is no problem during tracheal intubation, it is necessary to consider postintubation tracheal injury in patients with subcutaneous emphysema that worsens despite appropriate treatment after septorhinoplasty including osteotomy.
Anesthesia ; Delayed Diagnosis ; Diagnosis ; Humans ; Intubation ; Intubation, Intratracheal ; Lacerations ; Mediastinal Emphysema ; Osteotomy ; Pneumothorax ; Subcutaneous Emphysema

Subcutaneous emphysema is a rare complication of maxillofacial and dental surgery, and may be life-threatening because it can rapidly spread to the scalp, neck, and chest. We report a case of severe subcutaneous emphysema with pneumomediastinum during restorative dentistry in a child with difficulty in communication. The patient was hospitalized for conservative treatment and discharged after complete recovery as a result of timely diagnosis and treatment. Dentists and pediatricians should be aware of potential subcutaneous emphysema during dental treatment, with careful monitoring to ensure prompt diagnosis and treatment.
Child ; Dentistry ; Dentists ; Diagnosis ; Humans ; Mediastinal Emphysema ; Neck ; Oral Surgical Procedures ; Pediatrics ; Scalp ; Subcutaneous Emphysema ; Thorax ; Tooth Extraction

OBJECTIVES: The objective of this study was to analyze 11 cases of subcutaneous emphysema associated with dental procedures from a single hospital and discuss approaches for accurate diagnosis and treatment of the condition. MATERIALS AND METHODS: The medical records of 11 patients who were treated for subcutaneous emphysema related to dental procedures between January 2009 and April 2017 were analyzed retrospectively. Patients with subcutaneous emphysema within the facial area or that spread to the neck and beyond, including the facial region, were assigned to two groups and compared in terms of age, sex, and durations of antibiotic use, hospitalization, and follow-up until improvement. The correlation between location of the origin tooth and range of emphysema spread was analyzed. RESULTS: The average durations of antibiotic use during conservative treatment and follow-up until improvement were 8.55 days (standard deviation [SD], 4.46 days) and 1.82 weeks (SD, 1.19 weeks), respectively. There was no intergroup difference in duration of antibiotic use (P=0.329) or follow-up (P=0.931). Subcutaneous emphysema was more common after dental procedures involving the maxilla or posterior region than after those involving the mandible or anterior region. There was no significant difference in air distribution according to location of the air orifice (maxilla, mandible, or both; P=0.106). CONCLUSION: Upon adequate conservative treatment accompanied by prophylactic antibiotic treatment considering the risk of infection, patients showed signs of improvement within a few days or weeks. There was no significant difference in treatment period between patients with subcutaneous emphysema localized to the facial region and those with subcutaneous emphysema spreading to the neck or beyond. These findings need to be confirmed by analysis of additional cases.
Dental Care ; Diagnosis ; Emphysema ; Follow-Up Studies ; Hospitalization ; Humans ; Iatrogenic Disease ; Mandible ; Maxilla ; Mediastinal Emphysema ; Medical Records ; Neck ; Retrospective Studies ; Subcutaneous Emphysema* ; Tooth

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.
Barium ; Clavicle ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Medicine ; Head ; Humans ; Laryngoscopy ; Malingering ; Mediastinal Emphysema ; Neck ; Physical Examination ; Scalp ; Subcutaneous Emphysema

Traumatic bronchial injury (TBI) is rare and often fatal, usually a result of blunt or penetrating chest trauma. Clinical manifestations of TBI include pneumothorax, pneumomediastinum, subcutaneous emphysema and continuous air leakage despite thoracostomy with negative pressure. However, TBI is initially difficult to diagnose because its signs are similar to other chest traumas. Delayed diagnosis of TBI can result in sepsis, bronchial stenosis, hypoxic injury, and eventually can cause death. We experienced two patients with TBI, possibly a result of blunt chest trauma. We did not diagnose TBI in the emergency room because we did not suspect it. During surgery, we discovered right bronchial rupture, so performed end to end anastomosis of bronchus in two patients. This report discusses the rare occurrence of TBIs due to chest trauma; our aim is to increase awareness of this diagnosis in the trauma center.
Bronchi ; Constriction, Pathologic ; Delayed Diagnosis ; Diagnosis ; Emergency Service, Hospital ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Rupture ; Sepsis ; Subcutaneous Emphysema ; Thoracic Injuries ; Thoracostomy ; Thorax* ; Trauma Centers

BACKGROUNDPneumomediastinum (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.

METHODSWe 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.

RESULTSA 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.

CONCLUSIONSPM 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.

Child, Preschool ; Female ; Foreign Bodies ; complications ; Humans ; Infant ; Male ; Mediastinal Emphysema ; diagnosis ; Pneumothorax ; diagnosis ; Retrospective Studies ; Subcutaneous Emphysema ; diagnosis

ObjectiveTo compare the clinical effect of transumbilical single-port laparoscopy combined with improved double hernia needles with that of traditional open surgery in the treatment of hydrocele in children.

METHODSWe retrospectively analyzed 35 cases (54 sides) of pediatric hydrocele treated by transumbilical single-port laparoscopy combined with improved double hernia needles (laparoscopy group). We recorded the operation time, intraoperative blood loss, hospital stay, scrotal edema, and postoperative complications and compared them with those of another 46 cases (58 sides) treated by traditional open surgery (open surgery group) during the same period.

RESULTSThe laparoscopy group showed a significantly shorter operation time, less intraoperative blood loss, milder scrotal edema, and fewer hospital days than the open surgery group (all P<0.05). However, no statistically significant difference was found in the incidence of postoperative complications between the two groups (P>0.05). Subcutaneous emphysema developed in 2 patients in the laparoscopy group, which disappeared after 1－3 days of oxygen inhalation and other symptomatic treatment, while scrotal hematoma occurred in 1 and incision fat liquefaction in 2 patients in the open surgery group 3 days postoperatively, which healed after debridement suture and daily dressing, respectively. The patients were followed up for 3－6 months, which revealed no late complications in the laparoscopy group but 1 case of unilateral recurrence and 2 cases of offside recurrence in the open surgery group, all cured by laparoscopic internal ring ligation.

CONCLUSIONSTransumbilical single-port laparoscopy combined with improved double hernia needles is superior to traditional open surgery for the treatment of pediatric hydrocele and therefore deserves clinical generalization.

Blood Loss, Surgical ; Child ; Edema ; diagnosis ; Female ; Humans ; Laparoscopy ; instrumentation ; methods ; Length of Stay ; Ligation ; Male ; Needles ; Operative Time ; Postoperative Complications ; diagnosis ; surgery ; Postoperative Period ; Recurrence ; Retrospective Studies ; Scrotum ; Subcutaneous Emphysema ; etiology ; Testicular Hydrocele ; surgery ; Umbilicus