Papadiochos Ioannis Yiannis, Sarivalasis Stavros-Evangelos, Chen Meg, Goutzanis Lampros, Kalyvas Aristotelis
«Attikon» University General Hospital of Athens, Haidari, Greece.
Evaggelismos General Hospital of Athens, Athens, Greece.
Craniomaxillofac Trauma Reconstr. 2022 Mar;15(1):72-82. doi: 10.1177/1943387521997236. Epub 2021 Mar 4.
Pneumomediastinum (PM) secondary to oromaxillofacial trauma (OMF) is a rare but well-described complication/pathologic finding. The aim of this study was twofold: first, to report our experience in treatment of maxillofacial trauma patients with PM, and second, to review the literature regarding the clinical features, severity, course, and management of the aforementioned complication.
We retrospectively reviewed the medical records and charts of patients who suffered from maxillofacial trauma and treated in our hospital between September 1, 2013 and September 31, 2017. The inclusion criteria were patients with radiologically confirmed PM. In addition, the electronic databases PubMed, Scopus, and Science Direct were queried for articles reporting PM cases secondary to OMF injuries and published in English, French, and German language.
Three cases of PM out of 3,514 cases of craniomaxillofacial trauma were found; there were 3 male patients who presented in our emergency department with the chief complaint of cervicofacial swelling. Literature search isolated 58 selected articles and 63 cases were assessed in total; posttraumatic repeated blowing of nose was proved as most frequent triggering factor among them. Furthermore, the outcomes of review showed that thoracic pain, respiratory distress, and swallowing difficulties were not frequently reported in patients with ME due to facial trauma.
Both our experience and the results of systematic literature review indicated that patients with PM due to OMF injuries present mild clinical course. If properly managed, this specific pathologic condition may have no further complications or relative comorbidities. The exact etiology and mechanism of PM in the context of maxillofacial injuries always needs to be identified. Radiographic, laboratory, and endoscopic examinations should be applied to rule out the more serious and frequently diagnosed aerodigestive, thoracic, and abdominal causes of PM.
继发于口腔颌面部创伤（OMF）的纵隔气肿（PM）是一种罕见但有充分描述的并发症/病理表现。本研究的目的有两个：第一，报告我们治疗伴有PM的颌面创伤患者的经验；第二，回顾关于上述并发症的临床特征、严重程度、病程及处理的文献。
我们回顾性分析了2013年9月1日至2017年9月31日在我院接受治疗的颌面创伤患者的病历和图表。纳入标准为经放射学证实患有PM的患者。此外，还检索了电子数据库PubMed、Scopus和ScienceDirect，以查找报道OMF损伤继发PM病例且以英文、法文和德文发表的文章。
在3514例颅颌面创伤病例中发现3例PM；有3例男性患者因颈面部肿胀为主诉前来我院急诊科就诊。文献检索筛选出58篇文章，共评估63例病例；其中创伤后反复擤鼻被证明是最常见的触发因素。此外，综述结果显示，面部创伤所致PM患者中，胸痛、呼吸窘迫和吞咽困难并不常见。
我们的经验和系统文献综述结果均表明，OMF损伤所致PM患者临床病程较轻。如果处理得当，这种特殊的病理状况可能不会有进一步的并发症或相关合并症。颌面损伤情况下PM的确切病因和机制仍需明确。应进行影像学、实验室和内镜检查，以排除更严重且常见的导致PM 的气道消化道、胸部和腹部病因。
