A case of spontaneous pneumomediastinum and tension pneumothorax in a pediatric patient after elective dental procedure
Abstract
Subcutaneous emphysema of the head, neck, and mediastinum occurs most commonly in head and neck surgery, tracheal and esophageal injuries, facial skeleton injuries, foreign bodies in the gastrointestinal tract and gastrointestinal neoplasms, pulmonary barotrauma during mechanical ventilation, and after dental procedures, which is extremely rare.
The tooth preparation with a high-speed air turbine handpiece allows air to penetrate the mediastinum through the fascial spaces of the neck. Therefore, swelling of the face, neck, and upper body may often be misdiagnosed as an anaphylactic reaction to local or general anesthetics or other preparations used in dentistry. The paper presents a case of spontaneous pneumomediastinumand tension pneumothorax in a 2,5-year-old child after dental procedure. Dental treatment (extraction of 2 teeth, root canal filling of the mandibular right first molar) was carried out under general anesthesia. The early postoperative period was uneventful. In two hours, the parents with their child left private health care facility. Three hours after dental procedure, the parents noticed the child to develop an indurative edema of the right side of the face and neck, and immediately applied to the hospital. The therapy for angioedema was administered. Six hours after beginning therapy, there was observed a crepitation in the neck (circularly) and upper chest. The child was urgently transferred to the Department of Anesthesiology and Intensive Care of the Ivano-Frankivsk Regional Children’s Clinical Hospital. Pneumomediastinum was diagnosed via chest X-ray. Diagnostic bronchoscopy was performed under general anesthesia to exclude traumas to the laryngeal mucosa or injuries to the tracheobronchial tree. No visible local damage to the area examined was found. Drainage of the anterior mediastinum was performed emergently to save the child’s life. A control chest X-ray taken in two hours showed right-sided tension pneumothorax; the chest X-ray taken in four hours revealed left-sided spontaneous pneumothorax; the pleural cavities were drained using the Bülau-principle. Considering the increased cost of breathing and hypoxemia, the child was intubated and controlled mechanical ventilation was initiated. On the background of clinical improvement, the child was electively disintubated on the second day. The drainage tubes were removed from the pleural sinuses in 5 days. The control chest X-ray showed an improvement. The child was transferred to the Pulmonology Department and, on the 7th day of hospital stay, it was discharged home after recovery (Fig. 4, Ref. 14). Text in PDF www.lekarskyobzor.sk.
KEY WORDS: anaphylaxis, children, emphysema, pneumomediastinum.
Lek obz 2022, 72 (4): 187-190
Citácia:
SEMKOVYCH Y., SEMKOVYCH M., SYNOVERSKA O. a kol.: Prípad spontánneho mediastinálneho emfyzému a tenzného pneumotoraxu u pediatrického pacienta po dentálnom výkone. Lek obz 2022, 72 (4): 187-190
CITE
SEMKOVYCH Y., SEMKOVYCH M., SYNOVERSKA O. et al.: A case of spontaneous pneumomediastinum and tension pneumothorax in a pediatric patient after elective dental procedure. Lek obz 2022, 72 (4): 187-190
Yaroslav SEMKOVYCH 1, Mychailo SEMKOVYCH 2, Olga SYNOVERSKA 1, Oleksandr DOBROVANOV 3,4
1 Department of Children Diseases of Postgraduate Medical Education Faculty, Ivano-Frankivsk, Ukraine, head prof. O. Synoverska, MD, PhD.
2 Department of Anesthesiology and Intensive Care, Ivano-Frankivsk, Ukraine, head doc. Y. Semkovych, MD, PhD.
3 A. Getlik Clinic for Children and Adolescents of Slovak Medical University and University Hospital, Bratislava, head doc. MUDr. K. Furkova, CSc.
4 Slovak Medical University, Bratislava, head Dr.h.c. prof. MUDr. P. Šimko, CSc.
