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[Tracheostomy as a solution for subcutaneous emphysema and pneumomediastinum with severe respiratory failure].

Subcutaneous emphysema and pneumomediastinum have many causes. Generally they course without severe pathophysiological complications and severe respiratory complications are rare. However, cases with progressive dyspnea should be treated with tracheostomy or superficial incisions. A case is reported of a patient who underwent hip surgery under general anesthesia with tracheal intubation and later presented progressive dyspnea with subcutaneous emphysema and neuromediastinum. Tracheostomy yielded satisfactory results.

Aged↗

Massive subcutaneous emphysema following colonoscopy.

A case of massive subcutaneous emphysema following colonoscopic polypectomy is reported. The incidence of colonic perforation following colonoscopy is 0.1% and may be intraperitoneal or retroperitoneal. Intraperitoneal perforation is usually immediately apparent and likely to require urgent surgical exploration. The development of subcutaneous emphysema or a pneumoscrotum suggests a retroperitoneal perforation and in the majority of cases management is conservative. Contrast studies are often unhelpful but plain x-rays may help to distinguish between intraperitoneal and retroperitoneal perforations.

Aged↗

Diffuse subcutaneous emphysema, pneumomediastinum, and pneumothorax after dental extraction.

Subcutaneous emphysema, pneumomediastinum, and pneumothorax may result from surgical procedures and trauma and usually do not present a diagnostic dilemma. We present a case of subcutaneous emphysema, pneumomediastinum, pneumothorax, and pneumoretroperitoneum after a dental procedure with an air-and-water-cooled turbine burr drill. This allowed air and water under pressure to be driven into the field and track through the fascial planes. Although this is a common occurrence, these patients frequently go undiagnosed or misdiagnosed as allergic reactions to locally administered anesthetic agents. If a large amount of air is injected, it may track into not only the subcutaneous tissues but also the mediastinum, pleural space, and retroperitoneal space. Patients with significant amounts of air must be admitted, observed for airway compromise, and be provided IV antibiotics and hydration.

Adult↗

Subcutaneous emphysema of the thorax heralding colonic perforation.

Subcutaneous emphysema of the thorax may follow thoracic operations for a number of essentially benign reasons and does not usually cause much concern to the thoracic surgeon. We report subcutaneous emphysema of the thorax heralding a retroperitoneal colonic perforation in a patient who had undergone coronary artery bypass grafting 3 days previously.

Aged↗

Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy.

OBJECTIVE: To determine independent predictors for the development of hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy. METHODS: We reviewed 968 laparoscopic cases between January 1, 1997, and December 31, 1998. Patients who had hypercarbia (end-tidal carbon dioxide of 50 mmHg or greater), pneumothorax/pneumomediastinum, and subcutaneous emphysema were compared with controls according to age, operative time, type of surgery, extraperitoneal or intraperitoneal approach, preexisting medical conditions, body mass index, sex, use of Hasson technique, and number of surgical ports. Maximum positive end-tidal CO(2) (PETCO(2)) was added as an independent variable for subcutaneous emphysema, pneumothorax, and pneumomediastinum. Data were analyzed using univariate analysis and then subjected to multivariate analysis using multiple logistic regression analysis. RESULTS: Incidence rates were 5.5% for hypercarbia, 2.3% for subcutaneous emphysema, and 1.9% for pneumothorax/ pneumomediastinum. Independent risk factors for development of hypercarbia were operative time greater than 200 minutes (odds ratio [OR] 2.02), patient age greater than 65 years (OR 2.19), and Nissen fundoplication surgery (OR 3.18). Predictors of the development of subcutaneous emphysema were PETCO(2) greater than 50 mmHg (OR 3.49), operative time greater than 200 minutes (OR 5.27), and the use of six or more surgical ports (OR 3.06). Variables that predicted the development of pneumothorax and/or pneumomediastinum were PETCO(2) greater than 50 mmHg (OR 4. 15) and operative time greater than 200 minutes (OR 20.49). CONCLUSION: Longer operative times, higher maximum measured end-tidal CO(2), greater number of surgical ports, older patient age, and Nissen fundoplication surgery predispose patients to hypercarbia-related complications during laparoscopy.

Adult↗

Subcutaneous emphysema of the neck and colonic perforation.

Subcutaneous emphysema may result from pathological changes in the thorax or lung, as a result of localised infection with gas producing organisms, after abdominal procedures, or herald an intestinal perforation. The location and spread of extraperitoneal gas is determined by the anatomical barriers and fixed fascial layers surrounding the region of pathological change. The case highlights the extent of extraperitoneal gas after colonic perforation despite minimal clinical features and the importance of intra-abdominal causes of cervical subcutaneous emphysema.

Colonic Diseases↗

[Subcutaneous emphysema as a complication of tooth extraction].

Subcutaneous emphysema is a rare complication in dentistry, which may lead to diagnostic errors and inadequate therapy. A 17 year old female patient, in whom the separation of tooth roots was performed by the use of air-powered drill during the extraction of the first right lower molar, is presented in this paper. During the intervention, swelling of the right half of the face and the lower eyelid suddenly occurred, accompanied with simultaneous feeling of choking, and pressure in the neck and chest. Because of the suspicion of the allergic reaction, the patient was administered antihistaminic agent, together with parenteral corticosteroid, and was sent to an institution where she was treated as an in-patient. During hospitalization, subcutaneous emphysema of the face and neck was diagnosed by physical and x-ray examination. The emphysema completely disappeared after the use of oxygen and antibiotics.

Adolescent↗

Subcutaneous emphysema secondary to dental treatment: case report.

Subcutaneous emphysema is a relatively rare complication of dental treatment, although increasingly due to the use of high pressure air instruments. Many cases go unrecognized or are misdiagnosed. Majority of patients with this complication resolve spontaneously after 5 to 10 days, however some can advance to potentially life-threatening complications. A case of subcutaneous emphysema during restorative procedure in a 52-year-old woman was treated in the Docent Odontological Clinic of the Frontera University is presented. The differential diagnosis and management of this condition is discussed. Our purpose is not to add one more case of emphysema to literature, but to show dentists that in simple restorative procedures using air pressure instruments, they could be exposed to this complication.

Female↗

Massive subcutaneous emphysema mimicking necrotizing fasciitis after dacryocystorhinostomy.

We present a case of massive subcutaneous emphysema mimicking necrotizing fasciitis after uncomplicated dacryocystorhinostomy surgery. Subcutaneous emphysema progressing down fascial planes of the head and neck after dacryocystorhinostomy has not been reported in the literature. Using the clinical presentation and radiographic imaging, we briefly review the underlying cause of subcutaneous emphysema after dacryocystorhinostomy.

Adult↗

Subcutaneous emphysema secondary to pulmonary cavity in absence of pneumothorax or pneumomediastinum.

Subcutaneous emphysema is a common condition occurring after chest injury. It may also be observed in association with pneumothorax or pneumomediastinum as a result of pathological changes in the respiratory tract. Spontaneous subcutaneous emphysema in absence of pneumothorax or pneumomediastinum is rare. We report a case of spontaneous subcutaneous emphysema in isolation secondary to fibrocavitatory lesion in the chest along with review of the literature.

Eyelids↗

Subcutaneous emphysema after restorative dental treatment.

Subcutaneous emphysema is an uncommon phenomenon in dentistry, usually occurring with the use of air-driven, high-speed handpieces during dental and oral surgery, operative, endodontic, or periodontal treatment. Air is forced into a surgical wound or subepithelial laceration in the oral cavity, dissecting through the different layers of tissue fasciae, and usually creating a unilateral enlargement of the facial and/or submandibular regions. This occurs with or without crepitus, pain, and airway obstruction. Treatment usually consists of antibiotic and mild analgesic therapy, close observation, and reassurance by the attending dentist. Symptoms generally subside in 3 to 10 days; however, consultation with a physician is necessary to rule out further complications.

Administration, Oral↗