Conclusion
The present case study describes a high-velocity mastoid bone injury-causing SCE. A fracture of the mastoid bone should be included in the workup of a head and neck traumatic injury. A well-pneumatized mastoid can absorb forceful impacts, protecting middle and inner ear structures. On the set of a mastoid fracture, the Valsalva maneuver can have a catalytic effect on SCE formation but is not a prerequisite, since an adequate force of impact can by itself disseminate air from the mastoid to the surrounding soft tissues. Patients may initially present with minimal symptoms, but their condition may deteriorate rapidly or insidiously, especially in settings of mediastinal emphysema.
Acknowledgements
No other individual contributed to this paper. Published with written consent of the patient.
Conflict of interest
None declared.
Author contributions
Dimitrios Paouris: contributed to writing—original draft. Jana Barkociová: contributed to project administration, writing - review, visualization. Irina Šebová: contributed to supervision
References
1) Ahmed, Y., and Ng, M. 2016. Extensive cervicomediastinal emphysema from mastoid injury. Craniomaxillofacial trauma & reconstruction,9 (4), 338-341.
2) Paouris, D., Kunzo, S., and Šebová, I. 2021. Subcutaneous emphysema with pneumomediastinum after elective tonsillectomy-Case study. Otolaryngology Case Reports, 21, 100356.
3)Schwarz, Y., Sichel, J. Y., and Attal, P. 2019. Nasal blowing induces subcutaneous emphysema post penetrating mastoid tip trauma. International journal of pediatric otorhinolaryngology, 117, 48-50.
4)Gök, H., Şeker, S., Peker, H. O., Çal, M. A., Altay, T., and Çelik, S. 2020. A rare case report: Cervical subcutaneous and mediastinal emphysema due to mastoid fracture. Ulus Travma Acil Cerrahi Derg, 26(2), 328-330.
5) Lee, J. Y., Zovickian, J., Wang, K. C., and Pang, D. 2012. Subcutaneous cervical emphysema associated with mastoid fracture. Child’s nervous system, 28(3), 489-491.
6) Johnson, F., Semaan, M. T., and Megerian, C. A. 2008. Temporal bone fracture: evaluation and management in the modern era. Otolaryngologic Clinics of North America, 41(3), 597-618.
7) Vattakuzhiyil, G., and Konstantinidis, I. 2002. An unusual case of surgical emphysema in the neck following sport injury. The Journal of Laryngology & Otology, 116(1), 73-74.
8)Taguchi, Y., Sakakibara, Y., Uchida, K., and Kishi, H. (2004). Orbital emphysema following nose blowing as a sequel of a snowboard related head injury. British journal of sports medicine, 38(5), e28-e28.
9)Ilea, A., Butnaru, A., Sfrângeu, S. A., Hedeşiu, M., Dudescu, C. M., Berce, P., and Albu, S. 2014. Role of mastoid pneumatization in temporal bone fractures. American Journal of Neuroradiology, 35(7), 1398-1404.
10)Massmann, A., Garcia, P., Pizanis, A., Roth, C., Nieder, C., Schneider, G., and Bücker, A. 2012. Atypical extensive extratemporal hyperpneumatization of the skull base including the cervical spine: case report and review of the literature. Spine, 37(3), E199-E202.
11)Swarts, J. D., Alper, C. M., Luntz, M., Bluestone, C. D., Doyle, W. J., Ghadiali, S. N., … and Tideholm, B. 2013. Panel 2: Eustachian tube, middle ear, and mastoid—anatomy, physiology, pathophysiology, and pathogenesis. Otolaryngology—Head and Neck Surgery, 148(4_suppl), E26-E36.
12)Alper, C. M., Kitsko, D. J., Swarts, J. D., Martin, B., Yuksel, S., Cullen Doyle, B. M., … and Doyle, W. J. 2011. Role of the mastoid in middle ear pressure regulation. The Laryngoscope, 121(2), 404-408.
13)Ulano, A. C., Vedantham, S., & Takhtani, D. (2017). Revisiting the indirect signs of a temporal bone fracture: air, air, everywhere. Emergency radiology, 24(5), 497-503.