CASE DESCRIPTION
A 1-year-old boy was brought to the emergency department with a fever after experiencing an oral cavity injury caused by a toothbrush. The preceding morning, with his parents momentarily distracted, the boy had fallen while brushing his teeth. His toothbrush got stuck in his throat, and his mother forcefully removed it. On checking the boy’s mouth, the mother could see no bleeding or injuries. At a dental clinic, an examination the same day by a dentist revealed no active bleeding, and the boy was allowed to return home. Although the boy had done well at home during the day, a fever started during the night and continued into the next day.
On the boy’s arrival in the emergency department, his vital signs were stable except for a temperature of 37.7°C. On physical examination, no bleeds or injuries in his mouth were evident. A complete blood count and basic metabolic panel were unremarkable. Contrast-enhanced head-to-chest computed tomography revealed mediastinal emphysema across a wide area, including the left common and internal carotid arteries (Figure 1). Visualization using a laryngeal fiberscope revealed an injury to the left oropharyngeal wall, permitting air to enter the mediastinum (Figure 2).
The boy was admitted to our hospital for careful monitoring and administration of antibiotics. Fortunately, he was discharged 8 days later without his condition worsening.