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Massive subcutaneous emphysema developing before surgery for mandibular fracture: a case report.

Tomoki Sumida¹, Ayumi Kobayashi, Ryota Oka

¹Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of Medicine, Japan. tomoki@m.ehime-u.ac.jp

Dental Traumatology : Official Publication of International Association for Dental Traumatology

|May 12, 2010

Summary

Massive subcutaneous emphysema before intubation is a rare and potentially lethal complication. This case highlights preoperative emphysema caused by bag-valve-mask pressure in a patient with a mandibular fracture and intra-oral wound.

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Area of Science:

Medicine
Anesthesiology
Trauma Surgery

Background:

Preoperative subcutaneous emphysema is exceptionally rare and can be life-threatening.
Iatrogenic causes of subcutaneous emphysema often occur during or after surgery due to tissue injury.
Mandibular fractures with intra-oral wounds present unique challenges in airway management.

Observation:

A patient with a mandibular fracture and an intra-oral wound developed massive subcutaneous emphysema prior to intubation.
The emphysema was attributed to positive pressure ventilation via a bag-valve mask.
The air spread into the submental space through the intra-oral wound.

Findings:

This case presents a unique instance of preoperative massive subcutaneous emphysema.
The mechanism involved barotrauma from bag-valve-mask ventilation exacerbating a pre-existing anatomical vulnerability.
The emphysema occurred before any surgical intervention or intubation.

Implications:

Awareness of this rare complication is crucial for anesthesiologists and trauma surgeons.
Careful bag-valve-mask ventilation technique is essential in patients with facial trauma and intra-oral communication.
Prompt recognition and management are vital to prevent potentially lethal outcomes from airway compromise.