Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Mar;12(1):70-74.
doi: 10.1055/s-0038-1667017. Epub 2018 Jul 26.

Acute Hyponasality (Closed Rhinolalia) and Craniomaxillofacial Fracture Suggest the Coexistence of Retropharyngeal Emphysema and Pneumomediastinum

Ioannis Papadiochos  1 , Stavros-Evangelos Sarivalasis  2 , Nickolaos Papadogeorgakis  2
Affiliations
Case Reports

Acute Hyponasality (Closed Rhinolalia) and Craniomaxillofacial Fracture Suggest the Coexistence of Retropharyngeal Emphysema and Pneumomediastinum

Ioannis Papadiochos et al. Craniomaxillofac Trauma Reconstr. 2019 Mar.

Abstract

Pneumomediastinum (PM) implies an abnormal condition where a collection of free air or gas is entrapped within the fascial planes of mediastinal cavity. It is considered as benign entity, but an uncommonly seen complication of craniofacial injuries. We report a case of a 63-year-old male patient with the presenting sign of closed rhinolalia who was diagnosed with retropharyngeal emphysema and PM due to a linear and nondisplaced fracture of midface. The patient cited multiple efforts of intense nasal blowing shortly after a facial injury by virtue of a motorcycle accident. He was admitted in our clinic for closer observation and further treatment. The use of a face mask for continuous positive airway pressure was temporarily interrupted, and high concentrations of oxygen were delivered via non-rebreather mask. Patient's course was uncomplicated and he was discharged few days later, with almost complete resolution of cervicofacial emphysema and absence of residual PM in follow-up imaging tests. Closed rhinolalia (or any acute alteration of voice) in maxillofacial trauma patients should be recognized, assessed, and considered within the algorithm for PM and retropharyngeal emphysema diagnosis and management. For every single case of cervicofacial emphysema secondary to facial injury, clinicians should maintain suspicion for retropharyngeal emphysema or PM development.

Keywords: cervicofacial emphysema; facial trauma; pneumomediastinum; retropharyngeal emphysema; rhinolalia; voice.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Scattered and lucent streaks owing to the presence of free air in the patient's neck.
Fig. 2
Fig. 2
( a ) The source of air leakage: the anterior maxillary wall. ( b and c ) The extensions of the air to various sites and spaces of cervicofacial region.
Fig. 3
Fig. 3
The air collections within the subcutaneous tissue of the left anterior chest wall (yellow arrow), behind the sternum (green arrow), and between the left common carotid and subclavian artery (red arrow) in transverse view.
Fig. 4
Fig. 4
( a , b , and c ) Depiction of the air collections of both maxillofacial and thoracic regions after 3D reconstruction.
See this image and copyright information in PMC

References

    1. Minton G, Tu H K. Pneumomediastinum, pneumothorax, and cervical emphysema following mandibular fractures. Oral Surg Oral Med Oral Pathol. 1984;57(05):490–493. - PubMed
    1. Demers G, Camp J L, Bennett D. Pneumomediastinum caused by isolated oral-facial trauma. Am J Emerg Med. 2011;29(07):841000–8.41E10. - PubMed
    1. Procacci P, Zanette G, Nocini P F. Blunt maxillary fracture and cheek bite: two rare causes of traumatic pneumomediastinum. Oral Maxillofac Surg. 2016;20(01):91–96. - PubMed
    1. Baumann M H, Sahn S A. Hamman's sign revisited. Pneumothorax or pneumomediastinum? Chest. 1992;102(04):1281–1282. - PubMed
    1. Bickley J. Hamman syndrome. Br J Hosp Med (Lond) 2016;77(03):191. - PubMed

Publication types

LinkOut - more resources