Case report
Pneumothorax, pneumomediastinum and pneumopericardium complications arising from a case of wisdom tooth extraction
Pneumotórax, pneumomediastino e pneumopericárdio como complicações decorrentes de um processo de extração do dente do siso
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Chen, H. Chang, H.-C. Liu, T.-T. Hung, W.-C. Huang" "autores" => array:5 [ 0 => array:4 [ "nombre" => "C.-H." "apellidos" => "Chen" "email" => array:1 [ 0 => "musclenet2003@yahoo.com.tw" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "H." "apellidos" => "Chang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "H.-C." "apellidos" => "Liu" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "T.-T." "apellidos" => "Hung" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "W.-C." "apellidos" => "Huang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei City, Taiwan" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei City, Taiwan" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Mackay Medicine, Nursing and Management College, Taipei City, Taiwan" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pneumotórax, pneumomediastino e pneumopericárdio como complicações decorrentes de um processo de extração do dente do siso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 641 "Ancho" => 1500 "Tamanyo" => 100427 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lung scan revealed a pneumothorax in the left pleural cavity (A) and the pneumopericardium (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tooth extraction is a very common dental procedure. During this procedure, compressed dry air is frequently applied to clear the operative field. On rare occasions, compressed air may lead to dissection of soft tissues proximal to the extraction site. Even more rarely, the air may penetrate into the mediastinum and pleural space. Here we report such a rare case, with severe air dissection caused by the use of compressed air during wisdom tooth extraction.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 25-year-old woman underwent surgical extraction of one of her left upper wisdom teeth (third molar) due to intermittent pain caused by impaction. She had no history of systemic disease. The dentist used compressed air to dry out the operative field during the procedure. The wound was closed with sutures and the patient tolerated the procedure well. Twelve hours later, the patient complained of epigastric pain and was brought to our emergency room. When she got to our hospital her vital signs were: temperature, 37<span class="elsevierStyleHsp" style=""></span>°C, heart rate, 78<span class="elsevierStyleHsp" style=""></span>beats/min, respiratory rate, 24/min and blood pressure 114/70<span class="elsevierStyleHsp" style=""></span>mmHg. She did not present with any abdominal tenderness. The peritoneal signs were also negative. She only stated she had a dull pain in the epigastric region. After observation for 2<span class="elsevierStyleHsp" style=""></span>h, the patient's initial epigastric pain resolved but she started to complain of retrosternal pain and mild dyspnea. The oxygenation (SpO<span class="elsevierStyleInf">2</span>) was 99% with an oxygen cannula at 2<span class="elsevierStyleHsp" style=""></span>L/min. She presented with an elevated body temperature (38.5<span class="elsevierStyleHsp" style=""></span>°C), tachypnea (30/min) and tachycardia (heart rate: 110<span class="elsevierStyleHsp" style=""></span>beats/min).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Saturation was maintained at approximately 99% with the oxygen cannula at 2<span class="elsevierStyleHsp" style=""></span>L/min. Physical examination showed palpable subcutaneous emphysema involving the submandibular region, anterior and lateral aspect of the neck, as well as the bilateral supraclavicular regions. There were minor inflammatory signs but there was no local dental infection. Chest radiograph showed pneumomediastinum and subcutaneous emphysema in the neck region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A computed tomography scan was performed that showed: emphysema extending from the mandibular region to the mediastinum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B), as well as the presence of pneumopericardium and left side pneumothorax (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and B) The laboratory tests showed slightly elevated white counts 12400/μL without shift-to-left. The band form was 4% and the segmented form was 80% of total leukocytes. C-reactive protein was 7.4<span class="elsevierStyleHsp" style=""></span>mg/dL. After treatment with a second-generation cephalosporin administered intravenously along with oxygen and oral non-steroid anti-inflammatory drug, the fever subsided within 24<span class="elsevierStyleHsp" style=""></span>h after admission and the symptoms resolved. The patient was discharged 4 days later. After discharge, the patient took oral first-generation cephalosporin for an additional five days. She had a complete clinical and radiological recovery without recurrence of disease (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The simultaneous occurrence of emphysema, pneumothorax, pneumopericardium and pneumomediastinum, after dental treatment, is rarely reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Pousios et al. reported a 29-year-old man who had undergone the extraction of his right lower wisdom teeth. He presented similar symptoms of dyspnea and substernal pain as in our case. Air dissection was found to extend from the mandibular region to the mediastinum. She was treated with a 5-day oral anti-inflammatory agent regimen. Air dissection to the level of the pneumopericardium and pneumothorax is even more rare, and very serious. In dental surgical procedures, the soft tissues are opened in order to extract the impacted teeth. When the wound is created, potential surgical dissection planes appear. For ease of observation and operation, continuous compressed air of high flow may be required, but the air has the potential to penetrate into the soft tissues and cause damage. The potential dissection planes include wounds of the gingiva, hypopharynx, cervical fascia, pre-tracheal and para-tracheal fascia of the anterior mediastinum. When the pressure of emphysema has increased to a certain extent, the mediastinal pleura may rupture and then the air will accumulate in the pleural space, namely a pneumothorax. Because the operated oral cavity is not sterile, such a procedure carries a risk of deep neck infection, mediastinal infection and even pleural space infection. The prolonged use of compressed air may result in a pneumothorax, as in this patient's clinical case. Tension pneumothorax, sepsis, and air embolism may be lethal if not appropriately treated.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Another potential cause is the use of hydrogen peroxide.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Because of the existence of such potentially fatal complications, careful attention should be given to patients presenting with chest pain after recent tooth extraction. If fever develops, mediastinal infection ought to be considered in the differential diagnosis and should be treated promptly.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Pulmonary complications, although rare, may arise in patients after dental procedures. Physicians should be aware of the possibility of this happening. Careful observation of the clinical course and appropriate conservative treatment usually solves the problem.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres547814" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec565694" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres547813" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec565693" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-07-02" "fechaAceptado" => "2011-12-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565694" "palabras" => array:2 [ 0 => "Pneumothorax" 1 => "Mediastinal infection" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565693" "palabras" => array:2 [ 0 => "Pneumotórax" 1 => "Infeção do mediastino" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 25-year-old woman underwent surgical tooth extraction. Several hours after the procedure, the woman complained of severe retrosternal pain and mild dyspnea. Subsequent imaging revealed subcutaneous emphysema from the mandibular region extending to the mediastinum and left side pneumothorax, as well as pneumopericardium. After treatment with antibiotics and analgesics, the patient recovered without any complications.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Uma mulher de 25 anos foi submetida a uma extração dentária. Várias horas após o procedimento, a mulher queixou-se de dor retroesternal aguda e dispneia ligeira. Imagiologia posterior revelou enfisema subcutâneo da região mandibular estendendo-se ao mediastino e pneumotórax à esquerda, bem como pneumopericárdio. Após o tratamento com antibióticos e analgésicos, a paciente recuperou sem quaisquer complicações.</p></span>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1207 "Ancho" => 950 "Tamanyo" => 95539 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph showed prominent subcutaneous emphysema in the neck region and air density was also observed in the paratracheal region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 592 "Ancho" => 1400 "Tamanyo" => 95949 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Soft tissue scan revealed subcutaneous emphysema extending from a high level of mandible (A) to mediastinum (B).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 641 "Ancho" => 1500 "Tamanyo" => 100427 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lung scan revealed a pneumothorax in the left pleural cavity (A) and the pneumopericardium (B).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1177 "Ancho" => 950 "Tamanyo" => 98140 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Follow-up chest radiograph showed complete resolution of subcutaneous emphysema and pneumothorax.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iatrogenic pneumomediastinum and facial emphysema after surgical tooth extraction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Pousios" 1 => "N. Panagiotopoulos" 2 => "N. Sioutis" 3 => "A. Piyis" 4 => "S. Gourgiotis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2009.05.008" "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2010" "volumen" => "89" "paginaInicial" => "640" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20103370" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous emphysema and pneumomediastinum after dental extraction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.C. Chen" 1 => "F.Y. Lin" 2 => "K.J. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "1999" "volumen" => "17" "paginaInicial" => "678" "paginaFinal" => "680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10597088" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Arai" 1 => "T. Aoki" 2 => "H. Yamazaki" 3 => "Y. Ota" 4 => "A. Kaneko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.tripleo.2008.12.019" "Revista" => array:6 [ "tituloSerie" => "Oral Surg Oral Med Oral Pathol Oral Radiol Endod" "fecha" => "2009" "volumen" => "107" "paginaInicial" => "e33" "paginaFinal" => "e38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19201622" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous emphysema and pneumomediastinum secondary to dental extraction: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.C. Yang" 1 => "T.H. Chiu" 2 => "T.J. Lin" 3 => "H.M. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1607-551X(09)70366-3" "Revista" => array:6 [ "tituloSerie" => "Kaohsiung J Med Sci" "fecha" => "2006" "volumen" => "22" "paginaInicial" => "641" "paginaFinal" => "645" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17116627" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implications, prevention and management of subcutaneous emphysema during endodontic treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.E. Battrum" 1 => "J.L. Gutmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Endod Dent Traumatol" "fecha" => "1995" "volumen" => "11" "paginaInicial" => "109" "paginaFinal" => "114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7641625" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iatrogenic pneumomediastinum after endodontic therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O. Nahlieli" 1 => "A. Neder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Oral Surg Oral Med Oral Pathol" "fecha" => "1991" "volumen" => "71" "paginaInicial" => "618" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2047105" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000001800000004/v2_201509041425/S0873215912000141/v2_201509041425/en/main.assets" "Apartado" => array:4 [ "identificador" => "9580" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001800000004/v2_201509041425/S0873215912000141/v2_201509041425/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000141?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 9 | 27 |
| 2024 October | 167 | 33 | 200 |
| 2024 September | 199 | 28 | 227 |
| 2024 August | 213 | 39 | 252 |
| 2024 July | 216 | 39 | 255 |
| 2024 June | 175 | 54 | 229 |
| 2024 May | 153 | 38 | 191 |
| 2024 April | 113 | 33 | 146 |
| 2024 March | 142 | 25 | 167 |
| 2024 February | 133 | 31 | 164 |
| 2024 January | 94 | 23 | 117 |
| 2023 December | 106 | 21 | 127 |
| 2023 November | 112 | 33 | 145 |
| 2023 October | 112 | 37 | 149 |
| 2023 September | 130 | 36 | 166 |
| 2023 August | 116 | 22 | 138 |
| 2023 July | 141 | 22 | 163 |
| 2023 June | 133 | 21 | 154 |
| 2023 May | 132 | 25 | 157 |
| 2023 April | 123 | 16 | 139 |
| 2023 March | 148 | 23 | 171 |
| 2023 February | 114 | 21 | 135 |
| 2023 January | 105 | 21 | 126 |
| 2022 December | 122 | 22 | 144 |
| 2022 November | 160 | 41 | 201 |
| 2022 October | 165 | 22 | 187 |
| 2022 September | 143 | 27 | 170 |
| 2022 August | 138 | 35 | 173 |
| 2022 July | 144 | 48 | 192 |
| 2022 June | 153 | 39 | 192 |
| 2022 May | 115 | 32 | 147 |
| 2022 April | 138 | 33 | 171 |
| 2022 March | 168 | 43 | 211 |
| 2022 February | 142 | 30 | 172 |
| 2022 January | 135 | 34 | 169 |
| 2021 December | 92 | 39 | 131 |
| 2021 November | 102 | 34 | 136 |
| 2021 October | 123 | 33 | 156 |
| 2021 September | 107 | 38 | 145 |
| 2021 August | 142 | 36 | 178 |
| 2021 July | 144 | 20 | 164 |
| 2021 June | 242 | 23 | 265 |
| 2021 May | 327 | 43 | 370 |
| 2021 April | 829 | 65 | 894 |
| 2021 March | 690 | 23 | 713 |
| 2021 February | 418 | 14 | 432 |
| 2021 January | 381 | 15 | 396 |
| 2020 December | 444 | 13 | 457 |
| 2020 November | 516 | 23 | 539 |
| 2020 October | 327 | 22 | 349 |
| 2020 September | 468 | 21 | 489 |
| 2020 August | 517 | 29 | 546 |
| 2020 July | 561 | 22 | 583 |
| 2020 June | 536 | 34 | 570 |
| 2020 May | 406 | 20 | 426 |
| 2020 April | 342 | 8 | 350 |
| 2020 March | 450 | 14 | 464 |
| 2020 February | 440 | 13 | 453 |
| 2020 January | 474 | 23 | 497 |
| 2019 December | 478 | 22 | 500 |
| 2019 November | 490 | 16 | 506 |
| 2019 October | 552 | 26 | 578 |
| 2019 September | 620 | 27 | 647 |
| 2019 August | 690 | 17 | 707 |
| 2019 July | 605 | 25 | 630 |
| 2019 June | 578 | 24 | 602 |
| 2019 May | 653 | 19 | 672 |
| 2019 April | 707 | 23 | 730 |
| 2019 March | 730 | 19 | 749 |
| 2019 February | 594 | 9 | 603 |
| 2019 January | 812 | 22 | 834 |
| 2018 December | 461 | 8 | 469 |
| 2018 November | 231 | 0 | 231 |
| 2018 October | 247 | 8 | 255 |
| 2018 September | 206 | 7 | 213 |
| 2018 August | 467 | 22 | 489 |
| 2018 July | 416 | 18 | 434 |
| 2018 June | 270 | 15 | 285 |
| 2018 May | 347 | 17 | 364 |
| 2018 April | 196 | 21 | 217 |
| 2018 March | 180 | 18 | 198 |
| 2018 February | 25 | 4 | 29 |
| 2018 January | 47 | 14 | 61 |
| 2017 December | 52 | 4 | 56 |
| 2017 November | 117 | 7 | 124 |
| 2017 October | 178 | 11 | 189 |
| 2017 September | 170 | 21 | 191 |
| 2017 August | 202 | 12 | 214 |
| 2017 July | 163 | 16 | 179 |
| 2017 June | 36 | 18 | 54 |
| 2017 May | 56 | 19 | 75 |
| 2017 April | 52 | 7 | 59 |
| 2017 March | 78 | 12 | 90 |
| 2017 February | 94 | 4 | 98 |
| 2017 January | 178 | 9 | 187 |
| 2016 December | 81 | 6 | 87 |
| 2016 November | 317 | 9 | 326 |
| 2016 October | 228 | 12 | 240 |
| 2016 September | 346 | 8 | 354 |
| 2016 August | 357 | 11 | 368 |
| 2016 July | 135 | 10 | 145 |
| 2016 June | 9 | 0 | 9 |
| 2016 May | 8 | 0 | 8 |
| 2016 April | 172 | 3 | 175 |
| 2016 March | 305 | 10 | 315 |
| 2016 February | 252 | 15 | 267 |
| 2016 January | 257 | 11 | 268 |
| 2015 December | 229 | 6 | 235 |
| 2015 November | 199 | 4 | 203 |
| 2015 October | 245 | 9 | 254 |
| 2015 September | 785 | 10 | 795 |
| 2015 August | 288 | 6 | 294 |
| 2015 July | 364 | 14 | 378 |
| 2015 June | 171 | 2 | 173 |
| 2015 May | 221 | 11 | 232 |
| 2015 April | 254 | 9 | 263 |
| 2015 March | 295 | 8 | 303 |
| 2015 February | 190 | 5 | 195 |
| 2015 January | 243 | 10 | 253 |
| 2014 December | 190 | 12 | 202 |
| 2014 November | 198 | 15 | 213 |
| 2014 October | 232 | 4 | 236 |
| 2014 September | 231 | 12 | 243 |
| 2014 August | 232 | 11 | 243 |
| 2014 July | 219 | 9 | 228 |
| 2014 June | 211 | 8 | 219 |
| 2014 May | 211 | 16 | 227 |
| 2014 April | 195 | 16 | 211 |
| 2014 March | 223 | 14 | 237 |
| 2014 February | 208 | 12 | 220 |
| 2014 January | 219 | 17 | 236 |
| 2013 December | 256 | 21 | 277 |
| 2013 November | 236 | 27 | 263 |
| 2013 October | 249 | 19 | 268 |
| 2013 September | 154 | 16 | 170 |
| 2013 August | 186 | 11 | 197 |
| 2013 July | 150 | 31 | 181 |
| 2013 June | 125 | 14 | 139 |
| 2013 May | 127 | 21 | 148 |
| 2013 April | 115 | 37 | 152 |
| 2013 March | 111 | 28 | 139 |
| 2013 February | 100 | 34 | 134 |
| 2013 January | 136 | 31 | 167 |
| 2012 December | 82 | 23 | 105 |
| 2012 November | 56 | 30 | 86 |
| 2012 October | 61 | 22 | 83 |
| 2012 September | 50 | 22 | 72 |
| 2012 January | 138 | 0 | 138 |
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