2021 Volume 37 Issue 1 Pages 101-105
We experienced a case of severe mediastinal emphysema exacerbated by pharyngeal injury caused by a toothbrush. The case was a 2-year-old 2-month-old boy. He fell down with holding a toothbrush in the mouth. There was no damage to the toothbrush. From the next day, fever and swelling of the lower jaw were observed, and he visited a local physician. He was referred to our otolaryngologist for scrutiny without pharyngeal mucosal defects and referred to our department for the purpose of examining the fever source without finding any perforation in the laryngeal fiber. Percutaneous oxygen saturation (SpO2) decreased to 87% in room air, and computerized tomography (CT) showed extensive emphysema from the deep neck to the mediastinum. He was diagnosed with hypoxemia and the possibility of sudden exacerbation of emphysema, and was transferred to the Pediatric Intensive Care Unit (PICU). The patient was cured without any sequelae by ventilator management and antibiotic administration. Oral and pharyngeal injuries due to a toothbrush are clinically common, but there are many cases of minor injuries. Early physical examination of the neck and thoracic CT was considered to be effective in diagnosing worsening disease and deciding the treatment strategy if there were any physical findings and/or exacerbation of vital signs.
