Rare causes of soft tissue emphysema of the neck

Introduction:

Head and neck surgeons treat neck soft tissue emphysema predominantly. Therefore they should be familiar with its causes and complications. Every neck emphysema should be taken care of precisely because of possible life-threatening mediastinitis due to a quick spread along fascial neck planes. Trauma, tracheotomy or esophageal perforation are well known causes. However, rare causes in dental care and anesthesiology must also be considered and neck surgeons have to deal with them.

Methods:

Between 2014 and 2018 six patients with rare causes of neck emphysema with pneumomediastinum, are described in detail. The cause of mucosal injury was evaluated in these patients.

Results:

In 4 patients (67%) a mucosal injury to the floor of the mouth was identified, caused by a polishing device (controlled jet of water, air and fine powder) for tooth polishing. One patient suffered from pharyngeal injury by intubation with a laryngeal mask at an outpatient clinic. One further patient had a tracheal perforation after changing the endotracheal tubus intraoperatively. All patients showed clinical signs of an emphysema at the time they contacted us. CT scan showed excessive emphysema from the mediastinum up to the skull base in all cases. All patients were treated with antibiotics immediately and no further complications were seen.

Conclusions:

A neck emphysema can occur after different treatments, even if these are classified as harmless (tooth polishing, laryngeal mask). An immediate diagnosis and adequate treatment are essential for complete recovery of the patient.

Publication History

Publication Date:
23 April 2019 (online)