Mediastinal emphysema following fracture of the orbital floor

Abdelrahman, Husham; Shunni, Adam; El‐Menyar, Ayman; Ajaj, A.; Afifi, Ibrahim; Zarour, Ahmad; Al-Thani, Hassan

doi:10.1093/jscr/rju032

Cited by 13 publications

(13 citation statements)

References 11 publications

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“…In 2011 Rapp et al [34] analyzed nearly 70,000 elderly for falls that occurred in residences in Germany and observed a higher frequency of falls among male patients, and approximately 75% of the events occurred in the bedroom or bathroom. A previous study with a small sample size showed that elderly who sustained falls-related injury at bathroom were significantly associated with the female gender and high mortality rate [35].…”

Section: Discussionmentioning

confidence: 98%

Females Fall More From Heights But Males Survive Less Among A Geriatric Population: Insights From An American Level 1 Trauma Center

El‐Menyar

Tilley

Al-Thani

et al. 2019

Preprint

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Background: Approximately one third of subjects ≥65 year old and half of subjects ≥80 years old sustain a fall injury each year. We aimed to study the outcomes of fall from a height (FFH) among older adults. We hypothesized that in an elderly population, fall-related injury and mortality are the same in both genders. Methods: A retrospective analysis was conducted between January 2012 and December 2016 in patients who sustained fall injury at age of at least 60 years and were admitted into a Level 1 Trauma center. Patients were divided into 3 groups: Gp-I: 60-69, Gp-II: 70-79 and Gp-III: ≥80 years old. Data were analyzed and compared using Chi-square, one-way analysis of variance (ANOVA) and logistic regression analysis tests. Results: Forty-three percent (3665/8528) of adult trauma patients had FFH and 59.5% (2181) were ≥ 60 years old and 52% were women. The risk of fall increased with age with an Odd ratio (OR) 1.52 for age 70-79 and an OR 3.40 for ≥80. Females fell 1.2 times more (age-adjusted OR 1.24; 95% CI 1.05-1.45) and 47% of ≥80 years old suffered FFH. Two-thirds of FFH occurred at a height ≤1 meter. Injury severity (ISS, NISS and GCS) were worse in Gp-II, lower extremities max Abbreviated Injury score (max AIS) was higher in Gp-III. Overall mortality was 8.7% (Gp-I 3.6% vs. 11.3% in Gp-II and 14% in Gp- III). Males showed higher mortality than females in the entire age groups (Gp-I: 4.6% vs 1%, Gp-II: 12.9% vs 4.2% and Gp-III: 17.3% vs 6.9% respectively). On multivariate analysis, shock index (OR 3.80; 95% CI 1.27-11.33) and male gender (OR 2.70; 95% CI 1.69-4.16) were independent predictors of mortality. Conclusions: Fall from a height is more common in older adult female patients, but male patients have worse outcomes. Preventive measures for falls at home still are needed for the older adults of both genders.

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Section: Discussionmentioning

confidence: 98%

Females Fall More From Heights But Males Survive Less Among A Geriatric Population: Insights From An American Level 1 Trauma Center

El‐Menyar

Tilley

Al-Thani

et al. 2019

Preprint

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“…The unilateral facial emphysema increased over time as the patient sneezed and subsequently involved the neck spaces and chest wall down to the mediastinum implicating the endoscopic sinus surgery as a possible cause of the disease. Facial air collection can spread to the infratemporal fossa or the retropharyngeal and parapharyngeal spaces, and because the mediastinum has a good connection with the sublingual, submandibular, retropharyngeal and parapharyngeal spaces, and with the neck vessel sheaths, the facial air collection can disperse through these planes and find its way down to the mediastinum [9], [10].…”

Section: Discussionmentioning

confidence: 99%

A case report of unusual pneumomediastinum after endoscopic sinus surgery

Alomari

Alzoubi

Khatatbeh

2016

International Journal of Surgery Case Reports

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HighlightsWe report a case of rare and unusual complication of massive surgical emphysema involving orbit, face, neck and upper chest associated with pneumomediastinum in the first day post endoscopic sinus surgery.Pneumomediastinum should be suspected in if the patient develops a respiratory distress associated with massive periorbital, face and deep neck emphysema after endoscopic sinus surgery.Pneumomediastinum can be completely treated with conservative treatment. However, it can proceed to mediastinitis or septicemia and lead to the death.

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“…The lesion directly continues through the muscular inner layer of the buccinator muscle sublingual and submandibular spaces which are also connected with retropharyngeal, parapharyngeal, and pterygomandibular spaces. A subcutaneous air collection in the malar area, a possible consequence of orbital-maxillo-zygomatic complex fracture, can also spread to infratemporal fossa or to retropharyngeal, parapharyngeal, and pterygomandibular spaces [1,4,6,7]. An unusual origin of facial emphysema and even pneumomediastinum is the so-called pneumoparotitis.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of extensive pneumomediastinum, even pneumoperitoneum can therefore occur [12]. Other causes of subcutaneous emphysema and pneumomediastinum in trauma patients could be penetrating wounds, esophageal and tracheal rupture (including tracheostomy and endotracheal intubation), or infections caused by anaerobic bacteria with secondary aerobic bacteria colonization of the air collection [1,2,4,8,13]. Finally in some rare cases, pneumomediastinum can arise without any obvious portal and so-called idiopathic pneumomediastinum [3].…”

Section: Discussionmentioning

confidence: 99%

“…Until now, spontaneous pneumomediastinum, probably due to a fast increase of alveolar pressure, has been described as the rarest type of mediastinal emphysema, while posttraumatic and iatrogenic cases have been reported with a significantly higher incidence [3]. Oral and maxillofacial traumas are often associated with subcutaneous emphysema [1,4]. Usually, the most frequent factor responsible for the air spreading through the subcutaneous soft tissues is the posttraumatic interruption of the continuity of the bony walls of the pneumatic sinuses.…”

Section: Introductionmentioning

confidence: 99%

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Blunt maxillary fracture and cheek bite: two rare causes of traumatic pneumomediastinum

Procacci

Zanette

Nocini

2015

Oral Maxillofac Surg

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Subcutaneous facial emphysema is a well-known consequence of oral and maxillofacial traumatic injury. In some rare cases, the subcutaneous air collection could spread through the retropharyngeal and paralatero-cervical spaces, reaching the mediastinum. This clinical entity is known as pneumomediastinum and represents a severe and, sometimes, life-threatening condition. Other reported causes of pneumomediastinum are esophageal and tracheal traumatic or iatrogenic rupture. Finally, the so-called spontaneous pneumomediastinum is caused by a sudden increase in alveolar pressure and is usually seen in young men. We present two cases of pneumomediastinum as a consequence of unusual traumatic damage of orofacial tissues, followed by repeated sneezing and Valsalva maneuver.

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Mediastinal emphysema following fracture of the orbital floor

Cited by 13 publications

References 11 publications

Females Fall More From Heights But Males Survive Less Among A Geriatric Population: Insights From An American Level 1 Trauma Center

Females Fall More From Heights But Males Survive Less Among A Geriatric Population: Insights From An American Level 1 Trauma Center

A case report of unusual pneumomediastinum after endoscopic sinus surgery

Blunt maxillary fracture and cheek bite: two rare causes of traumatic pneumomediastinum

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