Spontaneous pneumomediastinum presenting as jaw pain during labor

BACKGROUND: Pneumomediastinum, or presence of free air within the mediastinum, is a rare complication of labor. Common symptoms of this condition include chest pain, dyspnea, and subcutaneous emphysema. CASE: A woman complained of right jaw pain 90 minutes after the onset of her second stage of labor. On examination, she was found to have swelling and crepitus over her face, neck, and supraclavicular region. A chest radiograph demonstrated a pneumomediastinum, which resolved spontaneously. CONCLUSION: Pneumomediastinum is associated with Valsalva maneuvers such as those seen during the second stage of labor. We report jaw pain as an unusual presenting symptom of this rare condition. Familiarity with the presenting symptoms of a pneumomediastinum is imperative for appropriate treatment and monitoring for significant complications. (Obstet Gynecol 2001;98:904-6. (C) 2001 by the American College of Obstetricians and Gynecologists.).