Introduction
Subcutaneous emphysema is a condition in which air becomes trapped
underneath the dermal layers of skin. The development of subcutaneous
air is a benign symptom or an indication of a deeper, more concerning
pathologic disease state. A history of head and neck injury can raise
suspicion and lead towards the identification of the cause of
subcutaneous air collection. Though temporal bone fractures are a
commoner entity in otorhinolaryngologic traumatology, published cases of
traumatic mastoid fractures are extremely rare in English literature.
Air may enter the subcutaneous neck tissues via penetrating or closed
non-penetrating external neck injuries. Air can also be intraluminally
dispersed in the neck and chest iatrogenically, or due to rupture of a
preexisting anatomical abnormality. Cervical and mediastinal emphysema
has been reported in a few cases post-tonsillectomy. Last but not least,
facial trauma and dental or maxillofacial procedures can have a similar
result. 1,2.
In our report, we present a case of mastoid apex fracture caused by a
high-velocity impact trauma leading to bilateral subcutaneous cervical
emphysema. Though unclear from the anamnesis, we believe the Valsalva
maneuver performed by the patient during nose-blowing, caused the spread
and entrapment of air through the soft tissue layers of the neck.