A Rare Case of Mediastinal and Cervical Emphysema Secondary Mandibular Angle Fracture: A Case Report

Subcutaneous emphysema in the head and neck is a well-known clinical entity usually associated with trauma to the facial bones and dentoalveolar surgery. Cervical, retropharyngeal, and mediastinal emphysema is a more severe manifestation associated with traumatic injuries to the facial bones and aerodigestive tract and is associated with potentially severe and even life-threatening complications. Mandibular fracture as a cause of mediastinal emphysema is rare, with only 4 cases having been reported in the literature. Mediastinal and cervical emphysema has been described after other maxillofacial injuries such as zygomaticomaxillary complex fractures, orbital blow-out fractures, naso-orbito-ethmoid fractures, and isolated maxillary sinus fractures. Iatrogenic emphysema has been reported and includes the use of air turbine dental drills, CO2 laser, O2 cryomachine, air abrasive system, endotracheal/ entilation in patients after dental surgical proceures, and endodontic treatment. Pneumomediastinum has been documented after orthognathic surgery and acute, transient episodes of respiratory bstruction, such as that produced by the Valsalva aneuver, violent coughing, and emesis.