Yatakbaşı Ultrason ile Tanı Konulan Künt Boyun Travmasının Geç Prezentasyonu

Abstract

Giriş: Tükrük bezi travmaları nadirdir ve en sık nedeni penetran travmalardır. Literatürde künt submandibuler bez travma bildirimleri azdır. Geç prezentasyon ve havayolu obstruksiyonu önemlidir. Radyolojik görüntüleme önemlidir ve acil tıp hekimleri yatakbaşı ultrason ile tanı koyabilir. Olgu Sunumu: 38 yaşında erkek hasta acil servisimize başka bir merkezden senkop sonrası submandibuler alanda şişlik nedeniyle tabruculuk sonrası başvurdu. Yatakbaşı ultrason sol submandibuler bezde sağa göre büyüme, bezde hipoekojenik çizgilenme ve periglandüler sıvı birikimi gösterdi. İntravenöz kontrastlı boyun bilgisayar tomografisi tanıyı doğruladı. Sonuç: İzole submandibuler tükrük bezi yaralanması nadirdir ve en sık nedeni motorlu taşıt kazalarıdır. Minor travmalar geç prezentasyona neden olabilir ve hastalar acil servise başka semptomlarla başvurabilirler. Etkilenen alanın yatakbaşı ultrason etkilenen bezdeki yaralanmayı saptayabilir ve akut durumda olası havayolu obstruksiyonu hakkında hekimi uyarabilir.

Keywords

• Submandibuler bez, travma, boyun travması, yatakbaşı ultrason

Delayed Presentation of Blunt Neck Trauma Diagnosed with Bedside Ultrasonography

Abstract

Introduction: Trauma of the salivary glands is rare, as penetrating traumas account for the majority of them. Few cases of blunt trauma of the submandibular glands are reported in the literature. Delayed presentation and airway compromise are the main concerns. Radiologic imaging is essential for diagnosis, where emergency physicians can diagnose with bedside ultrasonography.Case Report: A 38-year-old male presented to our emergency department after discharge from another hospital following enlargement of the submandibular area. Bedside ultrasound showed enlargement of the left submandibular gland with a hypoechogenic line through the gland with preglandular fluid collection when compared to the right side. Computed tomography of the neck with intravenous contrast agent confirmed the diagnosis.Conclusion: Isolated injury of the submandibular gland is rare, where the majority of reported cases is caused by MVCs. Minor appearing trauma can cause delayed presentations where the patient can re-present to the ED with more distinct findings. A bedside ultrasonography of the involved area can detect any abnormality of the affected gland and alert the physician for any possible airway compromise in the acute setting

Keywords

• Submandibular gland, trauma, neck injuries, bedside ultrasound

References

1. Nahlieli O, Droma EB, Eliav E, Zaguri A, Shacham R, Bar T.. Salivary gland injury subsequent to implant surgery. Int J Oral Maxillofac Implants 2008; 23: 556-60.
2. Roebker JJ, Hall LC, Lukin RR. Fractured submandibular gland: CT findings. J Comput Assist Tomogr 1991; 15: 1068-9. [CrossRef]
3. Tonerini M, Fratini L, Grassi L, Ravenna V, Tozzini A, Trincavelli F, et al. Blunt submandibular gland trauma: acute CT findings. Emerg Radiol 2002; 9: 116-8. [CrossRef]
4. Boyd BC, Dattilo DJ, Liberto FJ. An unusual supplemental vehicle restraint-induced injury: report of case and review of literature. J Oral Maxillofac Surg 2002; 60: 1062. [CrossRef]
5. Harbison Jm, Page MP. Submandibular gland injury and delayed airway compromise caused by a seat belt. Am J Otolaryngol 2010; 31: 209-11. [CrossRef]
6. Crystal CS, Masneri DA, Hellums JS, Kaylor DW, Young SE, Miller MA, et al. Bedside ultrasound for the detection of soft tissue foreign bodies: a cadaveric study. J Emerg Med 2009; 36: 377-80. [CrossRef]
7. Turkcuer I, Atilla R, Topacoglu H, Yanturali S, Kiyan S, Kabakci N, et al. Do we really need plain and soft-tissue radiographies to detect radiolucent foreign bodies in the ED? Am J Emerg Med 2006; 24: 763-8. [CrossRef]
8. Callegari L, Leonardi A, Bini A, Sabato C, Nicotera P, Spano E., et al. Ultrasound-guided removal of foreign bodies: personal experience. Eur Radiol 2009; 19: 1273-9. [CrossRef]

9. Hartgerink P, Fessell DP, Jacobson JA, van Holsbeeck MT. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterizationin 26 cases with surgical correlation. Radiology 2001; 220: 406-12. [CrossRef]
10. Roebker JJ, Hall LC, Lukin RR. Fractured submandibular gland: CT findings. J Comput Assist Tomogr 1991; 15: 1068-9. [CrossRef]