Intractable emphysema around the mandibular condyle: A case report

Subcutaneous emphysema of the face region has been reported to be a complication of dental procedures and trauma. Emphysema is usually self-limiting and is treated conservatively. This report describes a rare case of emphysema around the mandibular condyle, which did not recover naturally for more than 3 months. A 54-year-old man was referred for swelling of the left side of the face. While undergoing manual therapy at an osteopathic clinic, he heard an unusual noise and experienced severe pain in his left temporomandibular joint. Computed tomography of his head revealed massive air around the left condyle and fractures of the left condyle and glenoid fossa. These injuries were thought to have occurred during manual therapy at the osteopathic clinic. He was diagnosed with emphysema around the left side of the condyle and fractures of the left condyle and glenoid fossa. The injury generated an inflow path of air, with the emphysema thought to be caused by the surrounding soft tissue acting as a check valve. Condylar movement produced negative pressure within the joint space, trapping air in the extracapsular soft tissues. Movement of the masticatory muscle while eating may have acted as a pump to increase emphysema. The patient was treated with continuous negative pressure drainage, resulting in disappearance of the emphysema. This technique may be effective in treating subcutaneous emphysema of the face.