A Case Report of Mediastinal Emphysema and Laryngeal Edema due to Blunt Facial Trauma

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  • Amatsu Hisao
    Department of Otorhinolaryngology, Osaka City General Hospital
  • Oishi Masahiro
    Department of Otorhinolaryngology, Osaka City University Graduate School of Medicine
  • Wada Tadashi
    Department of Otorhinolaryngology, Osaka City University Graduate School of Medicine
  • Iguchi Hiroyoshi
    Department of Otorhinolaryngology, Osaka City University Graduate School of Medicine
  • Yamane Hideo
    Department of Otorhinolaryngology, Osaka City University Graduate School of Medicine

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Other Title
  • 顔面鈍的外傷後に縦隔気腫および喉頭浮腫を生じた1例
  • 症例 顔面鈍的外傷後に縦隔気腫および喉頭浮腫を生じた1例
  • ショウレイ ガンメン ドンテキ ガイショウ ゴ ニ ジュウカクキシュ オヨビ コウトウ フシュ オ ショウジタ 1レイ

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Abstract

It is rare that blunt facial trauma causes mediastinal emphysema or laryngeal edema, but delayed diagnosis or management can bring about a fatal outcome. Here we report the case of a 68-year-old male who presented with mediastinal emphysema and laryngeal edema due to blunt facial trauma. Riding a bicycle under the influence of alcohol, the patient fell down and bruised his right mandibular body. Throat discomfort and speech difficulties emerged gradually. Before he was referred to the Osaka City University Hospital, he had presented with epiglottic edema. Abrasion was found only on his face. Flexible endoscopy revealed swellings in the epiglottis and bilateral arytenoids which obstructed the airway. CT imaging showed fractures of orbital floor and orbital wall on the right side, and emphysema in the orbital canal, parapharyngeal space, and mediastinum. He was hospitalized in an emergency due to aggravation of dyspnea, and underwent a tracheostomy under local anesthesia. The patient was administered antibiotics along with a few days of fasting treatment and was discharged on the 29th hospital day after the airway obstruction and emphysema findings disappeared. In this case, emphysema was assumed to have been caused by hyperfine pharyngeal membrane tear, although not clearly revealed by ocular inspection or flexible endoscopy. Laryngeal edema was thought to have occurred by circulatory disturbance of the mucosa or inflammation. For patients with head or neck trauma, appropriate diagnosis and careful management are necessary in cases when laryngeal edema or mediastinal emphysema occur, regardless of the presence or absence of cervical or thoracic symptoms.

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