Saturday, November 9, 2013

The tissue paper that hides under your skin. Subcutaneous Emphysema.

There are the conditions that we read and learn about in vet school and can't fully understand until you see and feel it in person.

We learn about goose stepping and what kind of neurological condition it implies, but until you see a dog do it is just a foot note in the big cranial waste basket. You have to see it in person to appreciate that it does look exactly like it sounds.

Or, how about raspberry jam diarrhea. Yep, it looks exactly like the real thing.

The other day we saw Yeager, a Humane Society rescue dog with an abnormal facial swelling. Because veterinary medicine is practiced by the law of averages we assumed that Yeager, an older dog, had a bad tooth.

One of the most common ways that a pet with severe dental disease presents is with a swelling under the eye. (The other obvious way that a parent knows their pet has bad teeth is bad breath. IF your pet has bad breath I am willing to bet money that they have bad teeth. Have them checked ASAP, dental disease is the most common and most over looked pet health issue.)

How does this happen? Well, the tooth roots which are anchored in bone which is adjacent to the sinus cavity. The most classic facial swelling vets see is a periapical abscess of the upper fourth premolar, (the biggest tooth with the largest number of roots in the mouth). When the root gets an abscess it starts to swell and the easiest place for it to go is up toward the eye. If the swelling is allowed to continue it will eventually rupture and a draining tract will result.

Yeager is a difficult dog. He has abandoned the ability to provide a stranger the benefit of doubt. He prefers to growl, snarl, lunge and bite as an introductory "hello."

Unfortunately his demeanor required a muzzle for most of the handling he gets at the vets office. It is impossible to examine a dogs mouth with a muzzle on. And, for those patients with teeth that look bad the true test for the extent of dental disease, decay, and decisions lie in the dental x-rays.

Yeager was put under general anesthesia and the source of his swelling was at this point discovered to be a cut on the head from a fight.

Yeagers forehead sounded like tissue paper when you touched it. Commonly, we compare it to bubble wrap. When you press on the skin you can hear and feel a layer of popping crunching tissue just beneath the skin.

It is almost addicting to poke at.

What happens to produce this?

It is actually air trapped under the skin. And it crackles and pops when you press on it.

Air can be trapped by either trauma, where the skin is pulled from the subcutaneous tissue. Like separating layers of phyllo dough in baklava. If the skin is pulled out of its roots from the lower tissue layers and if there is a hole somewhere close that lets air in that air can get trapped between these layers.

It is called subcutaneous emphysema.

We see it in bite wounds, trauma, and tears in the trachea. Tears in the trachea can occur with intubation for anesthesia or bite wounds.

If the tear is a wound and the trachea is intact we usually can just watch, wait and provide pain management and antibiotics. We prescribe antibiotics because the air can actually be produced by bacteria that are trapped under the skin. Those bugs are trapped and they do what they always must do to survive. They eat, they replicate and their by-product is waste in the form of gas. 

For tears in the trachea surgical intervention is warranted. The thorax (chest cavity) needs to stay at a constant negative pressure for the lungs to bellow in their normal rhythmic in-and-out motion.

Any pet with subq emphysema, abnormal swelling, difficulty breathing, bad breath, or any signs of trauma should be seen by a veterinarian as soon as possible. Difficulty breathing is ALWAYS an emergency and should be seen immediately!

Yeager went back to the rescue with antibiotics and a careful note to monitor closely.

He is expected to make a full and uneventful recovery.

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If you have any pet related questions you can ask me, (and a whole bunch of incredibly smart people), at We are happy to help you and your pet and we are always free to use!

Or You can find me @FreePetAdvice on Twitter.

Have a wonderful weekend everyone! And please always be kind! And, one last thing, November is Adopt A Senior Pet Month. Please consider finding a place in your heart and your home for a pet in need.

Pheobe, adopted in the autumn of her life.
It saved her life and made her companion a happier less anxious pup.
Adopting an older pet will SAVE their life and it might enrich yours in more ways than you can imagine.
It is never about the length of your journey, but instead the steps you take along the way.


  1. Hi Y'all!

    Yeager was a lucky dog. His personality will probably be fine when he heals.

    Y'all come by now,
    Hawk aka BrownDog

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