• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.597-599
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• 2010

Subcutaneous emphysema and pneumomediastium is a relatively uncommon phenomenon. Most case of pneumomediastium are caused by iatrogenic injury on the cervical region and chest during tracheostomy. It is also well known that emphysema may occur secondary to dental treatment using high-speed air turbine handpiece, but there have been few cases of emphysema extended to involving the mediastinum. These complications are reported to occur mainly in patients after dental procedures, in particular during mandibular third molar extraction. Early recognition and conservative treatment of these problems is essential in preventing life-threatening complications such as airway obstruction, mediastinitis, pneumothorax and cardiac failure. As we report a case of 25-year-old woman with subcutaneous emphysema and pneumomediastium after mandibular third molar extraction using high-speed air turbine handpiece.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.696-699
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• 2005

Spontaneous pneumomediastinum(SPM) is an uncommon disease that is defined as the nontraumatic presence of free air in the mediastinum without any apparent underlying disease. We report a case of recurrent spontaneous pneumomediastinum without any direct precipitating cause. A 21-year-old woman was admitted to hospital suffering from chest pain that occurred during walking (?). She had previously been well. She did not complain of cough or vomiting prior to this presentation. Upon admission, the physical examination and Electrocardiogram findings were normal. The chest x-ray and chest computed-tomography showed a pneumomediastinum. She was successfully managed conservatively. Twenty seven months later, she was readmitted with chest pain, which again occurred during the same activity. The recurrent SPM was confirmed by the chest x-ray and chest computed-tomography. She was managed in the same manner as before and made an uneventful recovery. This is the first case of recurrent SPM in Korea.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.244-247
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• 1996

Multiple symmetric lipomatosis is a rare disease characterized by progressive growth of subcutaneous fat masses which are located symmetrically at neck, shoulders, chest, abdomen and groin. Recent surveys revealed a high incidence of combined somatic and autonomic neuropathy. The exact cause of the disease is not known. We have experienced one case of multiple symmetric lipomatosis with mediastinal involvement with symptomatic compression of trachea. The patient was a 55-year-male, complaining of dyspnea and slowly enlarging multiple symmetric masses at the neck, shoulders, chest, abdomen, flank and groin over a period of 10 years. He had a habit of excessive alcohol intake for many years. The fatty masses in the neck and the upper mediastinum including peritracheal region were excised through transverse cervical incision. But, because of the incomplete excision of peritracheal fatty tissue, we performed reoperation for the relief of residual tracheal compression at the 15th postoperative day. Two days later emergent tracheostomy was performed due to postoperative pneumomediastinum and subcutaneous emphysema. He could discharge with permanant tracheostomy.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.1014-1016
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• 1998

Rupture of the bronchus following endotracheal intubation with a double-lumen tube is extremely rare in all complications of endotracheal intubation. We experienced a case of left main bronchial rupture following endotracheal intubation. This 58-year old female patient was diagnosed of well-differentiated adenocarcinoma of right lower lobe, stage IIB, preoperatively. She was intubated with Robertshaw double-lumen tube(35 Fr.) for Rt. lower lobectomy. Intraoperatively, Lt. main bronchial rupture was suspected because of pneumomediastinum and ventilation insufficiency and immediately repaired with monofilament absorbable sutures(PDS) through left thoracotomy. Postoperative course was uneventful.

• Korean Journal of Bronchoesophagology
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• v.14 no.1
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• pp.50-53
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• 2008

Subcutaneous cervicofacial, mediastinal emphysemas are complications associated with head and neck surgery, trauma, infectious processes, tooth extraction. Drill cooling stream and dental syringe air ject are the sources of high pressure air that may enter exposed soft tissue. Since the introduction of the high-speed air turbine drill in the 1960s, The incidence of iatrogenic subcutaneous emphysema has increased. Most cases begin to resolve after 2 to 3 days and residual swelling is usually minimal at the end of 7 to 10 days. Surgical approach is not advised because it is likely to be ineffective. The differential diagnosis of neck swelling after dental procedure includes hematoma, cellulitis, angioedema, allergic reaction, subcutaneous emphysema. We report a rare case of patient with subcutaneous cervicofacial emphysema and mediastinal emphysema secondary to third molar extraction.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.208-212
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• 1996

From 1990 to 1994, 10 patients were treated for tracheobronchial injury due to blunt trauma. 7 injuries resulted from motor vehicle accident. Common presenting signs included subcutaneous emphysema, dyspnea and hemoptysis. The most common radiologic findings were pneumothorax, pneumomediastinum and hemothorax. The fiberoptic bronchoscopy was highly accurate method for the diagnosis. The operation method is simple closure except one patien underwent right pneumonectomy. One patient died because of respiratory distress and 9 patients recovered uneventfully and returned to normal activity. Early recognition and proper treatment of tracheobronchial injury is important.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.675-680
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• 2010

Background: The aim of this study was to identify the distinguishing clinicoradiologic findings of traumatic tracheobronchial injury. Material and Method: Between January 2003 and December 2009, six patients who underwent surgical repair for traumatic tracheobronchial injury due to blunt trauma were included in this study. We evaluated the mechanism of the injury, the coexisting injuries, the time until the making diagnosis and treatment, the diagnostic methods, the anatomic location of the injury and the surgical outcomes. Result: The mechanisms of injury were traffic accident and crushing forces. The frequent symptoms were subcutaneous emphysema, dyspnea and pain, and the common radiologic findings were pneumothorax, mediastinal emphysema, rib fracture and lung contusion. Only 2 patients were diagnosed by chest CT and the others were not diagnosed preoperatively. The location of injury was the trachea in 2 patients and the bronchial tree in 4 patients. There was no postoperative mortality or anastomotic leak; however, vocal cord palsy occurred in one patient. The most distinguishing sign was persistent lung collapse even though the chest tube was connected with negative pressure. Conclusion: Although it was not easy to diagnose traumatic tracheobronchial injury without a clinical suspicion, the distinguishing clinical symptoms and CT findings could help to make an early diagnosis without performing bronchoscopy.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.8.5-9
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• 1981

Foreign body in the esophagus is not uncommon in the otolaryngological field and esophageal perforation followed by mediastinitis is one of the most serious complications. Authors had experienced such case developed in 69 year old female patient. This woman swallowed a piece of sharp glass accidentally. Severe pain and swelling around the neck developed after ingestion. Marked subcutaneous emphysema was noted on first examination. By esophagoscopy, longitudinal laceration at right lateral wall of the cervical esophagus was noted and a lot of food debries were removed through this perforation, but foreign body could not be found. On third hospital day, patient complained chest pain and dyspnea. Mediastinal widening was noted on chest P-A. Tracheostomy was performed on next day and neck swelling decreased much. In spite of massive antibiotics, mediastinal abscess was developed and external drainage was performed on 15th hospital day. She was discharged on 38th hospital day with marked improvement and recovered completely on follow-up study. Still, we do not know where the foreign body is located.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.272-277
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• 2008

Background: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer. Methods: We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately $-89^{\circ}C$, and the icing time was 5~20 seconds. Results: Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications- one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality. Conclusion: This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.