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.