engleski

Cervicofacial subcutaneous emphysema after facial cosmetic procedure in an 11-year-old girl

Cervicofacial subcutaneous emphysema resulting from maxillofacial surgery and dental procedures is well described in the literature.1 Other causes include facial and chest trauma, infections, iatrogenic causes such as endotracheal intubation, positive pressure ventilation and cryotherapy.1–4 We report an 11-year-old girl who presented to the emergency department with swelling of her right cheek and neck. The swelling began soon after a cosmetic procedure for acne: mechanical cleaning of the skin pores followed by oxygen facial therapy. She also experienced a popping sensation, along with discomfort and swallowing difficulties. She had no significant medical history. There was no history of other traumatic events. She previously had the same cosmetic procedure four times without complications. On examination she had right hemifacial and neck swelling with crepitus and mild pain on palpation. There were no systemic symptoms of infection or fever. There were no signs of dyspnoea or chest pain. A standard craniogram revealed s.c. air in the right cheek and neck consistent with the diagnosis of cervicofacial s.c. emphysema (Fig. 1a, b). There was no signs of pneumomediastinum on a chest radiogram. Ultrasonography confirmed anechogenic interface anterior to muscles, which obscured the view of the structures other than skin and fat tissue. Her blood test results were unremarkable. The patient was admitted for monitoring and managed conservatively with the antibiotic clindamycin as a prophylaxis for infection. The emphysema gradually resorbed within 2 weeks. S.c. emphysema arises when air is forced beneath the tissues, leading to swelling, crepitus on palpation, and the potential of the air to spread along the fascial planes.1 Usually cervicofacial s.c. emphysema is a benign and self-limiting condition, although it also may have life-threatening complications such as pneumothorax and pneumomediastinum, cardiac tamponade, air embolism, tracheal compression and mediastinitis.1, 2 A comprehensive search of medical literature in PubMed showed that s.c. emphysema from a facial injury is rare and its extension into the cervical and mediastinal tissues is uncommon.1–5 We could find no case of facial s.c. emphysema caused by cosmetic procedures. Mechanical cleaning of facial skin pores is a commonly used cosmetic procedure for acne, while oxygen facial therapy is a recently introduced method. Oxygen therapy is typically performed using a small pen-like device called an airbrush, which is used to deliver high-pressure oxygen into the epidermis. It is presumed that oxygen has an antibacterial and restorative effect on the skin. We assume that in our patient the s.c. emphysema was a result of a small mechanical skin injury immediately followed by the application of high-pressure oxygen.

cervicofacial subcutaneous emphysema ; face ; cosmetic procedure

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