In the JournalsPerspective

E-cigarette explosion severely injures teen

Photo of Katie W. Russell
Katie W. Russell

An image recently published in The New England Journal of Medicine captured the injuries sustained by a teenage boy after an e-cigarette exploded in his face.

Katie W. Russell, MD, a pediatric surgeon from the University of Utah Health Care, told Infectious Diseases in Children that it is unclear what caused the e-cigarette to explode. However, lithium batteries have been implicated in other cases in which e-cigarettes have exploded.

“These injuries are more and more common with the increasing use of these devices,” she said. “There are at least 100 case reports.”

Russell and colleagues wrote that the 17-year-old boy presented to the ED 2 hours after the explosion with pain and swelling in the jaw. The patient was in stable condition and was not experiencing respiratory distress.

Upon examination, the patient suffered a circular puncture to the chin and numerous lacerations to the mouth. Additionally, the patient had several disrupted lower incisors and bony incongruity of the left mandible. A CT scan confirmed a comminuted and displaced mandibular fracture with disruption of the left central and lateral incisors.

Clinical image of teen injured by e-cigarette 
Source: The New England Journal of Medicine ©2019

Open reduction and internal fixation were needed, as well as dental extraction and removal of devitalized tissue. After 6 weeks, the patient adequately recovered, and the mandibular-maxillary fixation was removed.

Russell said the public has not been “adequately educated” about the risks associated with e-cigarettes.

“The best prevention is not smoking and not vaping,” she explained. – by Katherine Bortz

Disclosure: Russell reports no relevant financial disclosures.

Photo of Katie W. Russell
Katie W. Russell

An image recently published in The New England Journal of Medicine captured the injuries sustained by a teenage boy after an e-cigarette exploded in his face.

Katie W. Russell, MD, a pediatric surgeon from the University of Utah Health Care, told Infectious Diseases in Children that it is unclear what caused the e-cigarette to explode. However, lithium batteries have been implicated in other cases in which e-cigarettes have exploded.

“These injuries are more and more common with the increasing use of these devices,” she said. “There are at least 100 case reports.”

Russell and colleagues wrote that the 17-year-old boy presented to the ED 2 hours after the explosion with pain and swelling in the jaw. The patient was in stable condition and was not experiencing respiratory distress.

Upon examination, the patient suffered a circular puncture to the chin and numerous lacerations to the mouth. Additionally, the patient had several disrupted lower incisors and bony incongruity of the left mandible. A CT scan confirmed a comminuted and displaced mandibular fracture with disruption of the left central and lateral incisors.

Clinical image of teen injured by e-cigarette 
Source: The New England Journal of Medicine ©2019

Open reduction and internal fixation were needed, as well as dental extraction and removal of devitalized tissue. After 6 weeks, the patient adequately recovered, and the mandibular-maxillary fixation was removed.

Russell said the public has not been “adequately educated” about the risks associated with e-cigarettes.

“The best prevention is not smoking and not vaping,” she explained. – by Katherine Bortz

Disclosure: Russell reports no relevant financial disclosures.

    Perspective
    Harold J. Farber

    Harold J. Farber

    Severe injury from electronic cigarettes is not surprising. There is no regulation of the contents of e-cigarettes and no manufacturing standards. Although the full extent of severe injury from e-cigarettes is not known, we are seeing increasing reports.

    This is not the first report of severe injury from the battery of an e-cigarette exploding. Previous case reports include severe burns and severe eye injury from e-cigarette explosions. Life-threatening lung injury from e-cigarette use has been reported, including cases of hypersensitivity pneumonitis and asthma so severe the patient needed extracorporeal membrane oxygenation — essentially a lung bypass machine to get oxygen into the blood — for life support. Acute eosinophilic pneumonia, diffuse alveolar hemorrhage, lipoid pneumonia and cryptogenic organizing pneumonia are among the severe acute reactions that have been reported.

    Unfortunately, as e-cigarettes become more popular, we are likely to see more of these severe acute reactions. Over time, we are likely to see new types of diseases caused by e-cigarette use as well.

    • Harold J. Farber, MD, MSPH
    • Associate professor of pediatrics
      Pulmonary section
      Baylor College of Medicine
      Texas Children’s Hospital

    Disclosures: Farber reports no relevant financial disclosures.