Parapharyngeal emphysema after fracture of the tympanic portion of the temporal bone. A systematic review
Abstract Introduction and objective: To carry out a systematic review on the appearance of parapharyngeal emphysema as a complication of the fracture of the tympanic portion of the temporal bone after mandibular trauma. Method: A bibliographic review is carried out on this rare complication in the electronic databases PubMED, Web of Science and Cochrane. Results: The initial search offered a total of 31 results. Eight articles are selected by reading the title and abstract for full-text analysis and 6 of them are discarded according to the inclusion and exclusion criteria. Finally, 2 articles with published cases of parapharyngeal emphysema are included in the review and a new article published in this journal is incorporated. A total of 3 cases with a diagnosis of parapharyngeal emphysema secondary to fracture of the tympanic portion of the temporal bone are reviewed (2 men and 1 woman), aged between 36 and 79 years. The most frequent finding was otorrhagia (100% of cases), and management in all cases was conservative, with no long-term complications reported. Discussion: There are a series of factors that can favor this type of fractures and, therefore, the appearance of the complication in the form of parapharyngeal emphysema. Otorrhagia, hearing loss, stenosis of the external auditory canal or limitation of mouth opening are the most common findings. For its diagnosis, the use of computed tomography is important and its management is usually conservative. Conclusions: The high frequency of mandibular trauma and the little clinical impact that the fracture of the tympanic portion of the temporal bone may have suggests that there is an underdiagnosis of this type of fractures and, therefore, of its complication in the form of parapharyngeal emphysema.
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Benson JC, Lane JI. Temporal Bone Anatomy. Neuroimaging Clin N Am. 2022; 32(4):763-775.
Burchhardt D, David J, Eckert R, Robinette N, Carron M, Zuliani G. Trauma patterns, symptoms, and complications associated with external auditory canal fractures. Laryngoscope. 2015; 125(7):1579-1582.
Gomes MB, Guimarães SM, Filho RG, Neves AC. Traumatic fractures of the tympanic plate: a literature review and case report. Cranio. 2007; 25(2):134-137.
Jiang Y, Jiang C, Huang X. Associations between condylar fractures and external auditory canal fracture: A 7-year retrospective study. J Craniomaxillofac Surg. 2022; 50(2):140-145.
Altay C, Erdoğan N, Batkı O. Isolated tympanic plate fracture frequency and its relationship to mandibular trauma. Can Assoc Radiol J. 2014; 65(4):360-365.
Psimopoulou M, Antoniades K, Magoudi D, Karakasis D. Tympanic plate fracture following mandibular trauma. Dentomaxillofac Radiol. 1997; 26(6):344-346.
Baxter MC, Keller M, Shah A, Wise S. Surgical Emphysema Following Canalplasty for Aural Exostoses. Otol Neurotol. 2017; 38(8):1174-1177.
Chhabra N, Rezaee RP, Tucker HM, Megerian CA. Subcutaneous emphysema after otologic surgery: a case report. Am J Otolaryngol. 2012; 33(4):489-492.
Von Blumenthal H, Fisher EW, Adlam DM, Moffat DA. Surgical emphysema: a novel complication of aural exostosis surgery. J Laryngol Otol. 1994; 108(6):490-491.
Rodríguez-Martín Minerva, Corriols-Noval Patricia, López-Simón Eugenia, Salvatierra-Vicario Belén, Cobo-Díaz Ramón, García-Ibáñez Yaiza et al. Dehiscencia de pared anterior de conducto auditivo externo con afectación de articulación temporomandibular tras cirugía de exóstosis. Revisión sistemática. Rev ORL. 2023; 14(1): 55-61. https://doi.org/10.14201/orl.28559
Arechvo I, Giniunaite AM, Balseris S. Bilateral fracture of the styloid process with parapharyngeal emphysema. Otol Neurotol. 2014; 35(4): e155-e156.
Gök H, Şeker S, Peker HO, Çal MA, Altay T, Çelik S. A rare case report: Cervical subcutaneous and mediastinal emphysema due to mastoid fracture. Nadir bir olgu sunumu: Mastoid kırığı nedeniyle oluşan servikal subkutan ve mediastinal amfizem. Ulus Travma Acil Cerrahi Derg. 2020; 26(2):328-330.
Plaza G, Martínez-San Millán J, Navas C, Martínez-Vidal A. Parapharyngeal emphysema-an unusual complication of temporal bone trauma. J Laryngol Otol. 1998; 112(3):301-302.
Matos J, Oliveira P, Ferreira M, Conde A. Parapharyngeal space emphysema by temporal bone fracture resulting from mandibular trauma. Braz J Otorhinolaryngol. 2013; 79(4):525.
García-Fernández R, Gasós-Lafuente AM, Guallar-Larpa M, Lavilla-Martín de Valmaseda MJ. Enfisema parafaríngeo tras fractura de la porción timpánica del hueso temporal. Descripción de un caso. Rev ORL. 2023: e31791. https://doi.org/10.14201/orl.31791
Betz B, Wiener M. Air in the temporomandibular joint fossa: CT sign of temporal bone fracture. Radiology. 1991; 180(2):463-466.
Montaser A, Goyal M, Weiner M. Air in temporomandibular joint: an indirect, specific CT sign of temporal bone fracture in the setting of head trauma. J Trauma. 2011; 70(4):73.
Wood C, Hunt C, Bergen D. Tympanic plate fractures in temporal bone trauma: prevalence and associated injuries. Am J Neuroradiol. 2014; 35(1):186-190.
Burchhardt D, David J, Eckert R, Robinette N, Carron M, Zuliani G. Trauma patterns, symptoms, and complications associated with external auditory canal fractures. Laryngoscope. 2015; 125(7):1579-1582.
Gomes MB, Guimarães SM, Filho RG, Neves AC. Traumatic fractures of the tympanic plate: a literature review and case report. Cranio. 2007; 25(2):134-137.
Jiang Y, Jiang C, Huang X. Associations between condylar fractures and external auditory canal fracture: A 7-year retrospective study. J Craniomaxillofac Surg. 2022; 50(2):140-145.
Altay C, Erdoğan N, Batkı O. Isolated tympanic plate fracture frequency and its relationship to mandibular trauma. Can Assoc Radiol J. 2014; 65(4):360-365.
Psimopoulou M, Antoniades K, Magoudi D, Karakasis D. Tympanic plate fracture following mandibular trauma. Dentomaxillofac Radiol. 1997; 26(6):344-346.
Baxter MC, Keller M, Shah A, Wise S. Surgical Emphysema Following Canalplasty for Aural Exostoses. Otol Neurotol. 2017; 38(8):1174-1177.
Chhabra N, Rezaee RP, Tucker HM, Megerian CA. Subcutaneous emphysema after otologic surgery: a case report. Am J Otolaryngol. 2012; 33(4):489-492.
Von Blumenthal H, Fisher EW, Adlam DM, Moffat DA. Surgical emphysema: a novel complication of aural exostosis surgery. J Laryngol Otol. 1994; 108(6):490-491.
Rodríguez-Martín Minerva, Corriols-Noval Patricia, López-Simón Eugenia, Salvatierra-Vicario Belén, Cobo-Díaz Ramón, García-Ibáñez Yaiza et al. Dehiscencia de pared anterior de conducto auditivo externo con afectación de articulación temporomandibular tras cirugía de exóstosis. Revisión sistemática. Rev ORL. 2023; 14(1): 55-61. https://doi.org/10.14201/orl.28559
Arechvo I, Giniunaite AM, Balseris S. Bilateral fracture of the styloid process with parapharyngeal emphysema. Otol Neurotol. 2014; 35(4): e155-e156.
Gök H, Şeker S, Peker HO, Çal MA, Altay T, Çelik S. A rare case report: Cervical subcutaneous and mediastinal emphysema due to mastoid fracture. Nadir bir olgu sunumu: Mastoid kırığı nedeniyle oluşan servikal subkutan ve mediastinal amfizem. Ulus Travma Acil Cerrahi Derg. 2020; 26(2):328-330.
Plaza G, Martínez-San Millán J, Navas C, Martínez-Vidal A. Parapharyngeal emphysema-an unusual complication of temporal bone trauma. J Laryngol Otol. 1998; 112(3):301-302.
Matos J, Oliveira P, Ferreira M, Conde A. Parapharyngeal space emphysema by temporal bone fracture resulting from mandibular trauma. Braz J Otorhinolaryngol. 2013; 79(4):525.
García-Fernández R, Gasós-Lafuente AM, Guallar-Larpa M, Lavilla-Martín de Valmaseda MJ. Enfisema parafaríngeo tras fractura de la porción timpánica del hueso temporal. Descripción de un caso. Rev ORL. 2023: e31791. https://doi.org/10.14201/orl.31791
Betz B, Wiener M. Air in the temporomandibular joint fossa: CT sign of temporal bone fracture. Radiology. 1991; 180(2):463-466.
Montaser A, Goyal M, Weiner M. Air in temporomandibular joint: an indirect, specific CT sign of temporal bone fracture in the setting of head trauma. J Trauma. 2011; 70(4):73.
Wood C, Hunt C, Bergen D. Tympanic plate fractures in temporal bone trauma: prevalence and associated injuries. Am J Neuroradiol. 2014; 35(1):186-190.
García-Fernández, R., Gasós-Lafuente, A. M., Guallar-Larpa, M., & Lavilla-Martín De Valmaseda, M. J. (2024). Parapharyngeal emphysema after fracture of the tympanic portion of the temporal bone. A systematic review. Revista ORL, e31797. https://doi.org/10.14201/orl.31797
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