Air entrapment in the cervicofacial region due to injury

Air entrapment in the soft tissues of the cervicofacial region is a benign entity occasionally developing after a fracture of the facial bones or ribs. Characteristic clinical findings of air entrapment are the sudden onset of edema and crepitation of the respective region. Possible complications are respiratory obstruction or contamination of the mediastinum. Treatment includes precautionary administration of antibiotics. In regard to the region of injury, air may enter the anterior cranial fossa where it compresses the brain, resulting in pneumocephalus, which may cause meningitis as an imminent complication. After a fracture at the zygomatic or nasal bones, subcutaneous emphysema may result in the middle third of the face. It is also possible for air to penetrate into the retrobulbar fat and damage the eye. In other cases, air traverses the parapharyngeal space and causes pneumomediastinum. Moreover, after a fracture at the mandible, it is possible that air passes through the floor of the mouth and the submandibular area to the deep tissue layers again causing pneumomediastinum. Alternatively, after rib fracture, air could follow an upward course, resulting in subcutaneous emphysema of the thoracocervicofacial region. In this article, patients who suffered from air entrapment were categorized into four groups, and the methods used to diagnosis and treat these patients are presented.