Εμφύσημα Τραχηλοπροσωπικής Περιοχής.
Μάκος Χ.Π.1
Τμήμα Γναθοπροσωπικής Χειρουργικής, Γενικό Νοσοκομείο Κιλκίς, Α' Πε.Σ.Υ. Κεντρικής Μακεδονίας.
1. Γναθοχειρουργός, Επιμελητής Α'.
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής 4(4): 267 - 280, 2003.
ΠΕΡΙΛΗΨΗ
Το εμφύσημα της τραχηλοπροσωπικής περιοχής είναι επιπλοκή που σχετίζεται άμεσα με τις οδοντιατρικές
και γναθοχειρουργικές επεμβάσεις και τους τραυματισμούς στην περιοχή της στοματικής κοιλότητας,
του προσώπου του τραχήλου και οφείλεται στην περιορισμένη ή εκτεταμένη συγκέντρωση αερίου στον
υποδόριο συνδετικό ιστό ή και στα ανατομικά διαστήματα της περιοχής. Στις περισσότερες περιπτώσεις το
εμφύσημα είναι ήπιου τύπου και απορροφάται σταδιακά. Σε βαρείες και επιδεινούμενες περιπτώσεις μπορεί
να επεκταθεί προς το θώρακα με μηχανισμό όμοιο με αυτόν των οδοντογενών λοιμώξεων και να προκληθεί
εμφύσημα του μεσοθωρακίου ή μεσοπνευμονίου χώρου (πνευμομεσοπνευμόνιο) και πνευμοθώρακας
με πιεστικά φαινόμενα στο αναπνευστικό και κυκλοφορικό σύστημα θέτοντας σε κίνδυνο τη ζωή
του ασθενή. Πιο σπάνια, το εμφύσημα της τραχηλοπροσωπικής περιοχής μπορεί να οφείλεται και σε ανιούσας
ή κεφαλικής επέκτασης εμφύσημα του μεσοθωρακίου, το οποίο με τη σειρά του έχει προκληθεί
από τραυματισμούς περιοχών ή αεροφόρων οργάνων του κατωτέρου τραχήλου, του θώρακα ή της κοιλίας.
Στην εργασία αυτή παρουσιάζονται ενδεικτικά πέντε περιπτώσεις εμφυσήματος της τραχηλοπροσωπικής
περιοχής, μία εκ των οποίων ανιούσας φοράς και γίνεται μια ανασκόπηση στην προσιτή βιβλιογραφία
σχετικά με τα αίτια, την κλινική και ακτινογραφική εικόνα, τις επιπλοκές, τη διαφοροδιάγνωση, την αντιμετώπιση,
καθώς και την πρόληψη αυτής της κατάστασης.
Λέξεις κλειδιά: Εμφύσημα, τραχηλοπροσωπική περιοχή.
REFERENCES
Ademdprff D, Malherbe WDF, Grotepass F: Generalized surgical
emphysema as an early complication of facial fracture: A
Case Report. S Afr Med J 51: 722-724, 1977.
Ali A, Cunliffe DR, Watt-Smith SR: Surgical emphysema and
pneumomediastinum complicating dental extraction. Br Dent
J 188: 589-590, 2000.
Αντωνιάδης Κ, Βαχτσεβάνος Κ, Λαζαρίδης Ν, Καρακάσης Δ:
Εμφύσημα σε τραυματισμούς προσώπου, Ελλ. Στομ. Χρονικά
37: 173-179, 1993.
Aragon SB, Dolwick MF, Buckley S: Pneymomediastinum and
subcutaneous cervical emphysema during third molar
extraction under general anesthesia. J Oral Maxillofac Surg
44: 141-144, 1986.
Barker JW, Burns JB: Subcutaneous emphysema of the face and
neck after dental restoration. JADA 75: 167-169, 1967.
Belfiglio EJ, Fox LJ: Extensive subcutaneous emphysema
crossing the midline after a surgical extraction· report of case
JADA 112: 646-648, 1986.
Bembridge JL, Bembridge M: Pneymomediastinum during
general anesthesia. Can J Anesth 36: 75-77, 1989.
Berry CV: Surgical emphysema subsequent to the extraction of n
upper molar. S Afr Dent J 17:183, 1943. Αναφέρεται από:
Steiner M, Grau MJ, Wilson DL, Snow NJ: Odontogenic
infection leading to cervical emphysema and fatal
mediastenitis. J Oral Maxillofac Surg 40: 600-604, 1982.
Berry BE, Oschner JL: Perforation of the esophagus: a 30 year
review. J Thorac Cardiovasc Surg 65: 1-7, 1973.
Bhat KS: Tissue emphysema caused by hydrogen peroxide. Oral
Surg 38: 304-307, 1974.
Brown MW, Brown RC, Orr G: Pneymoperitoneum complicating
endoscopy in a patient with duodenal and jejunal diverticula
(letter). Gastrointest Endosc 32: 120-121, 1986.
Buckley MJ, Turvey TA, Schuman SP, Grimson BS: Orbital
emphysema causing vision loss after dental extraction. JADA
120: 421-424, 1990.
Capell MS, Marks M: Acute colonic diverticular perforation
presenting as left ear pain and facial swelling due to cervical
subcutaneous emphysema in a patient administered
corticosteroids. Am J Gastroenterol 87: 899-902, 1990.
Capes JO, Salon JM, Wells DL: Bilateral cervicofacial, axillary
and anterior mediastinal emphysema: A rare complication oi
third molar extraction. J Oral Maxillofac Surg 57: 996-999.
1999.
Chen RS, Chen TH: Extensive spread of subcutaneous
emphysema following an operative procedure. Operat Denl
11: 155-158, 1986.
Chuong R, Bolard TJ, Pirer MA: Pneumomediastinum anc
subcutaneous emphysema associated with temporomandibular
joint surgery. Oral Surg Oral Med Ora Pathol 74: 2-6
1992.
Cullen DJ, Caldera DL: The incidence of ventilation-inducec
pulmonary aroraumas in critically ill patients. Anestehsia 50
185-190, 1979.
Dattwyler RJ, Goldman MA, Boch KJ: Pneumomediastinum as ε
complication of asthma in teeanage and young dult patients
J Allergy Clin Immunol 63: 412-416, 1979.
Dames JM, Campbell LA: Fatal air embolism during denta
implant surgery: a report of three cases. Can J Anaesth 37
112-121, 1990.
De Man K, Wijngaarde R: Downward displacement of the ey<
resulting from orbital emphysema. J Maxillofac Surg 8: 152
154, 1980.
Demas PN, Braun TW: Infection associated with orbita
subcutaneous emphysema. J Oral Maxillofac Surg 49: 1239
1242, 1991.
Edwards DB, Scheffer RB, JAckler I: Postoperative pneymo
mediastinum and pneymothorax following orthognathy
surgery. J Oral Maxillofac Surg 44: 137-141, 1986.
Feinstone T: Infected subcutaneous emphysema: report of case
JADA 83: 1309-1311, 1971.
Girardi A, Piazza 1, Giunta G, Papagallo G: Retroperitoneal
mediastinal and subcutaneous emphysema as a complicatioi
of routine upper gastrointestinal endoscopy. Endoscopy 22
83-84, 1990.
Gray JM, Hanson GC: Mediastinal emphysema: aetiology
diagnosis and treatment. Thorax 21: 325-332, 1966.
Grodinsky M, Holyoke EA: The fasciae and facial spaces of th<
head, nee and adjacent regions. Am J Anat 63: 367-407
1938.
Habal MB, Beart R, Murray JA: Mediastinal emphysem; secondary to a fracture of the orbital floor. Am J Surg 123:
606-608, 1972.
Habal MB, Any an S: Facial fractures. Toronto, BC Decker Inc
1989, pp. 75.
Hamman L: Mediastinal emphysema. JAMA 128: 1-16, 1945.
Harvey-Smith W, Bush W, Northrop C: Traumatic bronchial
rupture. Am J Roentgenol 134: 1189-1193, 1980.
Hata T, Hosoda Mi Cervicofacial subcutaneous emphysema after
oral surgery. Br J Oral Maxillofac Surg 39: 161-162, 2001.
Henry CH, Hills EC: Traumatic emphysema of the head, neck
and mediastinum associated with maxillofacial trauma: Case
report and review. J Oral Maxillofac Surg 47: 876-882,
1989.
Heyman SN, Babayof I: Emphysematous complications in
dentistry, 1960-1993: an illustrative case and review of the
literature. Quintessence Int 26: 535-543, 1995.
Horowitz I, Hirshberg A, Freedman A: Pneumomediastinum and
subcutaneous emphysema following surgical extraction of
mandibular third molars: Three case reports. Oral Surg Oral
Med Oral Pathol 63: 25-28. 1987.
Hunt RB, Sahler OD: Mediastinal emphysema produced by air
turbine dental drills. JADA 205: 241-242, 1968.
Kaufman AY: Facial emphysema caused by hydrogen peroxide
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Kirsh MM, Orringer MB, Behrendt DM, Sloan H: Management of
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3ου γομφίου. Αναφορά δύο περιπτώσεων και βιβλιογραφική
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Τμήμα Γναθοπροσωπικής Χειρουργικής, Γενικό Νοσοκομείο Κιλκίς, Α' Πε.Σ.Υ. Κεντρικής Μακεδονίας.
1. Γναθοχειρουργός, Επιμελητής Α'.
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής 4(4): 267 - 280, 2003.
ΠΕΡΙΛΗΨΗ
Το εμφύσημα της τραχηλοπροσωπικής περιοχής είναι επιπλοκή που σχετίζεται άμεσα με τις οδοντιατρικές
και γναθοχειρουργικές επεμβάσεις και τους τραυματισμούς στην περιοχή της στοματικής κοιλότητας,
του προσώπου του τραχήλου και οφείλεται στην περιορισμένη ή εκτεταμένη συγκέντρωση αερίου στον
υποδόριο συνδετικό ιστό ή και στα ανατομικά διαστήματα της περιοχής. Στις περισσότερες περιπτώσεις το
εμφύσημα είναι ήπιου τύπου και απορροφάται σταδιακά. Σε βαρείες και επιδεινούμενες περιπτώσεις μπορεί
να επεκταθεί προς το θώρακα με μηχανισμό όμοιο με αυτόν των οδοντογενών λοιμώξεων και να προκληθεί
εμφύσημα του μεσοθωρακίου ή μεσοπνευμονίου χώρου (πνευμομεσοπνευμόνιο) και πνευμοθώρακας
με πιεστικά φαινόμενα στο αναπνευστικό και κυκλοφορικό σύστημα θέτοντας σε κίνδυνο τη ζωή
του ασθενή. Πιο σπάνια, το εμφύσημα της τραχηλοπροσωπικής περιοχής μπορεί να οφείλεται και σε ανιούσας
ή κεφαλικής επέκτασης εμφύσημα του μεσοθωρακίου, το οποίο με τη σειρά του έχει προκληθεί
από τραυματισμούς περιοχών ή αεροφόρων οργάνων του κατωτέρου τραχήλου, του θώρακα ή της κοιλίας.
Στην εργασία αυτή παρουσιάζονται ενδεικτικά πέντε περιπτώσεις εμφυσήματος της τραχηλοπροσωπικής
περιοχής, μία εκ των οποίων ανιούσας φοράς και γίνεται μια ανασκόπηση στην προσιτή βιβλιογραφία
σχετικά με τα αίτια, την κλινική και ακτινογραφική εικόνα, τις επιπλοκές, τη διαφοροδιάγνωση, την αντιμετώπιση,
καθώς και την πρόληψη αυτής της κατάστασης.
Λέξεις κλειδιά: Εμφύσημα, τραχηλοπροσωπική περιοχή.
REFERENCES
Ademdprff D, Malherbe WDF, Grotepass F: Generalized surgical
emphysema as an early complication of facial fracture: A
Case Report. S Afr Med J 51: 722-724, 1977.
Ali A, Cunliffe DR, Watt-Smith SR: Surgical emphysema and
pneumomediastinum complicating dental extraction. Br Dent
J 188: 589-590, 2000.
Αντωνιάδης Κ, Βαχτσεβάνος Κ, Λαζαρίδης Ν, Καρακάσης Δ:
Εμφύσημα σε τραυματισμούς προσώπου, Ελλ. Στομ. Χρονικά
37: 173-179, 1993.
Aragon SB, Dolwick MF, Buckley S: Pneymomediastinum and
subcutaneous cervical emphysema during third molar
extraction under general anesthesia. J Oral Maxillofac Surg
44: 141-144, 1986.
Barker JW, Burns JB: Subcutaneous emphysema of the face and
neck after dental restoration. JADA 75: 167-169, 1967.
Belfiglio EJ, Fox LJ: Extensive subcutaneous emphysema
crossing the midline after a surgical extraction· report of case
JADA 112: 646-648, 1986.
Bembridge JL, Bembridge M: Pneymomediastinum during
general anesthesia. Can J Anesth 36: 75-77, 1989.
Berry CV: Surgical emphysema subsequent to the extraction of n
upper molar. S Afr Dent J 17:183, 1943. Αναφέρεται από:
Steiner M, Grau MJ, Wilson DL, Snow NJ: Odontogenic
infection leading to cervical emphysema and fatal
mediastenitis. J Oral Maxillofac Surg 40: 600-604, 1982.
Berry BE, Oschner JL: Perforation of the esophagus: a 30 year
review. J Thorac Cardiovasc Surg 65: 1-7, 1973.
Bhat KS: Tissue emphysema caused by hydrogen peroxide. Oral
Surg 38: 304-307, 1974.
Brown MW, Brown RC, Orr G: Pneymoperitoneum complicating
endoscopy in a patient with duodenal and jejunal diverticula
(letter). Gastrointest Endosc 32: 120-121, 1986.
Buckley MJ, Turvey TA, Schuman SP, Grimson BS: Orbital
emphysema causing vision loss after dental extraction. JADA
120: 421-424, 1990.
Capell MS, Marks M: Acute colonic diverticular perforation
presenting as left ear pain and facial swelling due to cervical
subcutaneous emphysema in a patient administered
corticosteroids. Am J Gastroenterol 87: 899-902, 1990.
Capes JO, Salon JM, Wells DL: Bilateral cervicofacial, axillary
and anterior mediastinal emphysema: A rare complication oi
third molar extraction. J Oral Maxillofac Surg 57: 996-999.
1999.
Chen RS, Chen TH: Extensive spread of subcutaneous
emphysema following an operative procedure. Operat Denl
11: 155-158, 1986.
Chuong R, Bolard TJ, Pirer MA: Pneumomediastinum anc
subcutaneous emphysema associated with temporomandibular
joint surgery. Oral Surg Oral Med Ora Pathol 74: 2-6
1992.
Cullen DJ, Caldera DL: The incidence of ventilation-inducec
pulmonary aroraumas in critically ill patients. Anestehsia 50
185-190, 1979.
Dattwyler RJ, Goldman MA, Boch KJ: Pneumomediastinum as ε
complication of asthma in teeanage and young dult patients
J Allergy Clin Immunol 63: 412-416, 1979.
Dames JM, Campbell LA: Fatal air embolism during denta
implant surgery: a report of three cases. Can J Anaesth 37
112-121, 1990.
De Man K, Wijngaarde R: Downward displacement of the ey<
resulting from orbital emphysema. J Maxillofac Surg 8: 152
154, 1980.
Demas PN, Braun TW: Infection associated with orbita
subcutaneous emphysema. J Oral Maxillofac Surg 49: 1239
1242, 1991.
Edwards DB, Scheffer RB, JAckler I: Postoperative pneymo
mediastinum and pneymothorax following orthognathy
surgery. J Oral Maxillofac Surg 44: 137-141, 1986.
Feinstone T: Infected subcutaneous emphysema: report of case
JADA 83: 1309-1311, 1971.
Girardi A, Piazza 1, Giunta G, Papagallo G: Retroperitoneal
mediastinal and subcutaneous emphysema as a complicatioi
of routine upper gastrointestinal endoscopy. Endoscopy 22
83-84, 1990.
Gray JM, Hanson GC: Mediastinal emphysema: aetiology
diagnosis and treatment. Thorax 21: 325-332, 1966.
Grodinsky M, Holyoke EA: The fasciae and facial spaces of th<
head, nee and adjacent regions. Am J Anat 63: 367-407
1938.
Habal MB, Beart R, Murray JA: Mediastinal emphysem; secondary to a fracture of the orbital floor. Am J Surg 123:
606-608, 1972.
Habal MB, Any an S: Facial fractures. Toronto, BC Decker Inc
1989, pp. 75.
Hamman L: Mediastinal emphysema. JAMA 128: 1-16, 1945.
Harvey-Smith W, Bush W, Northrop C: Traumatic bronchial
rupture. Am J Roentgenol 134: 1189-1193, 1980.
Hata T, Hosoda Mi Cervicofacial subcutaneous emphysema after
oral surgery. Br J Oral Maxillofac Surg 39: 161-162, 2001.
Henry CH, Hills EC: Traumatic emphysema of the head, neck
and mediastinum associated with maxillofacial trauma: Case
report and review. J Oral Maxillofac Surg 47: 876-882,
1989.
Heyman SN, Babayof I: Emphysematous complications in
dentistry, 1960-1993: an illustrative case and review of the
literature. Quintessence Int 26: 535-543, 1995.
Horowitz I, Hirshberg A, Freedman A: Pneumomediastinum and
subcutaneous emphysema following surgical extraction of
mandibular third molars: Three case reports. Oral Surg Oral
Med Oral Pathol 63: 25-28. 1987.
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