Subcutaneous emphysema related to dental procedures

Cervicofacial Subcutaneous Emphysema and Pneumomediastinum Following Class V Resin Restoration: A Case Report

Air can become trapped within the subcutaneous layer of the cervicofacial area, a condition known as subcutaneous emphysema (SE), unexpectedly after routine dental procedures. SE can worsen by extending superiorly to the peri-orbital region and inferiorly to the thorax and abdomen along the fascial planes. Upward progression can result in cavernous sinus thrombosis. Conversely, downward progression can cause a variety of complications such as pneumothorax, mediastinitis, and compression of the venous trunks. The presence of these conditions highlights the significance of prompt identification, precise diagnosis to ascertain the need for immediate intervention, and suitable management to prevent additional unfavorable consequences.

Pronounced mediastinal emphysema after restorative treatment of the lower left molar-a case report and a systematic review of the literature

This case report presents an iatrogenic induced mediastinal emphysema after restorative treatment of the lower left second molar, aimed to highlight the potential life-threatening consequences, and providing diagnostics and treatment concepts of complicated dental induced emphysema based on literature review. A 74-year-old female patient was admitted to the emergency department due to a fall on her shoulder. Additional finding was a significant swelling of the face and neck. In the computer tomography of the head, neck, and thorax, a humerus fracture and pronounced soft tissue emphysema from the infraorbital region to the mediastinum was detected. The patient reported that she had been treated by her dentist 4 days earlier. The treatment had to be discontinued after beginning of a pronounced swelling. Other reasons for the emphysema could be excluded out on an interdisciplinary teamwork. The patient was monitored as an inpatient for 5 days and received intravenous antibiotic therapy. This case report shows the rare complication of pronounced mediastinal emphysema after root canal treatment. Emphysema should always be a differential diagnosis of soft tissue swelling and, in case of doubt, a general medical presentation should be made.

Pneumomediastinum after Third Molar Extraction: Case Report, Physiopathology, and Literature Review

Wisdom tooth extraction is a common procedure in dentistry and stomatology. Subcutaneous emphysema is a rare postoperative complication and commonly remains localized. However, it may spread to the mediastinum, endangering the life of the patient. This present paper presents a case study of pneumomediastinum after wisdom tooth extraction without the use of a compressed air turbine and reviews the cases of subcutaneous emphysema after third molar extraction published in the literature since 2010. The aim of this work is to inform preventive measures, pathophysiological processes, and management related to this complication.

With two episodes of right retromandibular angle subcutaneous emphysema during right upper molar crown preparation: A case report

BACKGROUND

Subcutaneous emphysema is a well-known complication of oral surgery, especially during mandibular wisdom tooth extraction. However, subcutaneous emphysema secondary to dental procedures such as crown preparation is rare. The main symptom of emphysema is swelling and crepitus on palpation. Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.

CASE SUMMARY

In this paper, we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions. The treatment plan for this patient involved close observation of the airway, and administration of dexamethasone and antibiotics via intravenous drip or orally. Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing. Although the main reason is unclear, the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation. It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.

CONCLUSION

This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications. Awareness of relatively “benign” subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists, but also for those who work in rural and remote settings as members of surgical teams. In this study, we review the clinical presentation, mechanism, and differential diagnosis of subcutaneous emphysema.

Extensive subcutaneous emphysema secondary to endodontic treatment

Subcutaneous emphysema is a relatively rare phenomenon, in the context of dentistry related to iatrogenic injury, with only 32 cases reported between 1993 and 2008. This article aims to discuss the relevance and importance of this issue to dentists, including how to identify the condition and its management.

Pneumomediastinum and subcutaneous emphysema secondary to dental extraction: Two case reports

BACKGROUND

Dental extraction is a common operation in oral surgery and is usually accompanied by pain, swelling, and local infection. The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive. However, high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum, which is a serious iatrogenic complication.

CASE SUMMARY

We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction. The first case involved a 34-year-old man who complained of swelling of the face, mild chest tightness, and chest pain after dental extraction. Computed tomography (CT) scan showed a large amount of gas in the neck, chest wall, and mediastinum. The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction. CT showed a large amount of gas collected in the neck and mediastinum. Both of them used high-speed turbine splitting during dental extraction.

CONCLUSION

High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema. Dentists should carefully operate to avoid emphysema. If emphysema occurs, CT can be used to improve the diagnosis. The patient should be informed, and the complications dealt with carefully.

Subcutaneous Emphysema Related to Dental Treatment: A Case Series

Cervicofacial subcutaneous emphysema (SE) is primarily caused by dental treatment introducing gas into the subcutaneous tissue. Air rapidly dissects into the subcutaneous tissue with face and neck swelling, leading to respiratory distress, patient discomfort, and chest pain. Computed tomography (CT) can detect spreading SE patterns. However, the true volume of SE and the degree of air changes in the body over time remain unknown. We evaluated the healing process of SE and the temporal changes in the volume of emphysema in three cases detected using our hospital’s electronic health record systems based on inclusion and exclusion criteria over the past 10 years, with CT and three-dimensional (3D) images. The first case was a 46-year-old woman who presented with complaints of swelling from her right eyelid to the neck and clavicles, pain on swallowing, respiratory distress, and hoarseness. The second case was a 35-year-old man who presented with complaints of swelling over the face. The third case was a 36-year-old man who presented with complaints of swelling from the left cheek to the neck. CT revealed SE and pneumomediastinum in all cases. All the patients were administered an antibacterial drug. The CT and 3D images showed an improvement in emphysema 3 days after the onset, with more than half of the volume reduction in emphysema. This made it possible to evaluate the changes in the air content of SE. Observation with CT until the healing process of SE is completed is crucial, and 3D images also help evaluate changes over time.

Subcutaneous Facial Emphysema Following Open-Flap Air-Powder Abrasive Debridement for Peri-Implantitis: A Case Report and an Overview

Subcutaneous facial emphysema related to dental treatments is a well-known clinical complication due to incidental or iatrogenic air or gas penetration into the subcutaneous tissues and fascial planes, leading to distension of the overlying skin. To the best of our knowledge, from 1960 to the current date, only six cases have been reported arising from peri-implant cleaning or non-surgical peri-implantitis treatment. Therefore, the present case of subcutaneous facial emphysema following open-flap air-powder abrasive debridement was the first report during surgical peri-implantitis therapy. Swelling on the left cheek and periorbital space suddenly arose in a 65-year-old woman during open-flap debridement with sodium bicarbonate air-powder abrasion (PROPHYflex™ 3 with periotip, KaVo, Biberach, Germany) of the infected implant surface. The etiology, clinical manifestations, diagnosis, potential complications, and management of subcutaneous emphysema are also briefly reviewed. The present case report draws the attention of dental practitioners, periodontists, oral surgeons, and dental hygienists to the potential iatrogenic risk of subcutaneous emphysema in using air-powder devices in implant surface debridement.

Subcutaneous emphysema during mandibular wisdom tooth extraction: Cases series

Subcutaneous emphysema occurs when air is forced under the tissue, causing swelling, crepitus on palpation, and the possibility of spreading along the fascial planes. Although subcutaneous emphysema secondary to dental procedures is rare, it can be a potentially fatal complication if not diagnosed and treated promptly and correctly. Dentists need to be able to differentiate subcutaneous emphysemas from more common disease processes that have similar clinical presentations. We report a 22-year-old male who underwent mandibular wisdom tooth extraction and subsequently developed extensive subcutaneous emphysema. The patient was quickly taken care of, in partnership with the maxillofacial department. The purpose of this report is to bring attention to the fact that obtaining an accurate diagnosis for this condition is very important and management on time can prevent serious complications.

Causes of subcutaneous emphysema following dental procedures: a systematic review of cases 1993-2020

Objectives Causes of subcutaneous emphysema (SE) following dental treatment have changed with new operative techniques and equipment. This review demonstrates the frequency and aetiology of SE to inform prevention strategies for reducing SE occurrences.Methods A systematic search of Medline, Embase and PubMed databases identified 135 cases of SE which met inclusion criteria after independent review by two authors. Trends in frequency and causes of SE were displayed graphically and significant differences in frequency of SE by time period, site and hospital stay were analysed using t-tests.Results Dental extractions often preceded development of SE (54% of cases), commonly surgical extractions. Treatment of posterior mandibular teeth most often resulted in development of SE. Most cases were iatrogenic, with 51% resulting from an air-driven handpiece and 9% from air syringes. Factors such as nose blowing accounted for 10%. There was a significant (p <0.05) increase in cases over time. Mandibular teeth had increased hospital stay time compared to maxillary teeth (p <0.01).Conclusion Increased risks of SE were identified following use of air-driven handpieces during dental extractions and when treating lower molar teeth. Use of air-driven handpieces should be avoided during dental extractions to reduce risks and subsequent morbidity that results from SE.

Subcutaneous facial emphysema secondary to a dental procedure

Subcutaneous emphysema is a possible but infrequent consequence of dental procedures. We present the case of a 6-year-old healthy boy transferred from a dental clinic immediately after local anaesthesia for tooth extraction, due to sudden orbital and facial swelling. On physical examination, oedema of the left upper eyelid with fine crepitus on palpation and left hemiface oedema with local pain were observed. Ophthalmologic observation was normal. CT scan of the face and orbits documented extensive infiltration of the subcutaneous tissue planes of the left face by air, with extension to the external part of the body of the mandible, retromaxillary fat, masticatory muscle spaces, parapharyngeal space and adjacent to the orbital roof. After completing initial evaluation, the dentist confirmed the use of an air-driven device during local anaesthesia administration. The patient improved with conservative treatment. Early recognition of this condition is essential to provide an adequate clinical assessment with exclusion of possible life-threatening complications.

Patient-induced progressive facial subcutaneous emphysema masquerading as odontogenic abscess

Facial subcutaneous emphysema (SE) is an uncommon sequelae of dental procedures and often attributed to the use of high-speed air-driven handpieces during surgical extractions, forcing air through fascial spaces. Rarely have there been documented cases of patient-induced SE. In this case report, we present an 18-year-old woman who was referred to the emergency department with a 5-day history of progressive swelling and pain to her right cheek, following a prolonged, but simple extraction of tooth 18. While the dentist and emergency physicians were concerned about an infectious aetiology, history taking, clinical review and imaging corroborated the diagnosis of patient-induced SE secondary to habitual straw use. This report highlights the need for routine postextraction counselling of sinus precautions irrespective of extraction complexity. Additionally, emergency physicians should be aware of SE masquerading as other pathology, including odontogenic abscesses, allergic reactions, angioedema and gas-forming bacterial infections, such as necrotising fasciitis, to ensure appropriate treatment is provided to patients.

Case Report: Atraumatic Orbital Emphysema after Bronchoscopy with Endobronchial Biopsy

SIGNIFICANCE

Orbital emphysema is a well-documented condition where air enters the orbital soft tissue typically because of direct or indirect trauma; however, atraumatic cases can be encountered. The following is a novel case report of acute unilateral atraumatic orbital emphysema 24 hours after bronchoscopy with endobronchial biopsy.

PURPOSE

To the best of the authors' knowledge, this is the first known case report of atraumatic orbital emphysema as a postprocedure complication of bronchoscopy with endobronchial biopsy in the literature.

CASE REPORT

A 74-year-old man presented with painless swelling of the left upper and lower eyelids upon awakening. The patient had a history of bronchoscopy and endobronchial biopsy with conscious sedation for a right upper lobe lung mass 24 hours before the visit. Slit-lamp examination revealed air entrapment in the left upper and lower lids with enlarged subconjunctival air pockets of the left eye. Head and maxillofacial computed tomography without contrast revealed extensive emphysema tracking and dissecting along the subcutaneous and deep soft tissue spaces of the neck and face that was more pronounced along the left side. The patient was admitted for overnight observation and prescribed a prophylactic oral course of 250 mg of azithromycin daily for 2 days by the attending hospitalist. The subsequent follow-up visit 3 days later revealed complete resolution of signs and symptoms.

CONCLUSIONS

This case report demonstrates the importance of considering orbital emphysema in patients with a history of recent bronchoscopy with endobronchial biopsy. Clinicians should be aware of this potential complication and refer for appropriate testing and comanagement.

Case Report: Subcutaneous Emphysema and Pneumomediastinum Following Dental Extraction

Introduction

Emergency physicians should be cognizant of complications following common procedures (including dental) and be able to readily care for patients with acute dental pain.

Case Report

A 22-year-old female presented with dental pain and difficulty swallowing that developed 48 hours after she underwent a dental extraction. The physical exam showed an uncomfortable, afebrile female with dysphonia, inability to tolerate secretions, and crepitus over the neck and anterior chest wall.

Discussion

The use of a high-speed dental drill may have caused air to dissect through fascial planes leading to subcutaneous emphysema, or even through deeper planes resulting in pneumomediastinum. It should be noted that subcutaneous emphysema and pneumomediastinum are rare complications of dental procedures.

Conclusion

This case highlights an uncommon but potentially life-threatening complication following a routine dental procedure, which emergency clinicians should be attentive to and able to identify and thereby manage.

Emphysema after Sinus Grafting: Importance of Patient's Information, Early Diagnosis, and Management

The sinus elevation procedure is a safe and predictable technique that allows the placement of implants in atrophic posterior maxillae. However, some recommendations have to be followed by the patient to ensure reliable healing. It is particularly important to avoid inducing trauma in the region concerned and through the sinuses. This report describes a rare complication that occurred after the grafting of a sinus, which was attributed to a violent sneeze a few hours after the intervention. The diagnosis of emphysema following air entry was confirmed by the suddenness of the swelling and associated crepitation, and by the radiographic observation of a delimited radiolucent zone in the grafted sinus. The immediate diagnosis and subsequent management prevented further adverse events. This case report supports the need for complete comprehensive instruction of patients after oral surgery, swift diagnosis, and management of emphysema.

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

Background

Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections.

Case presentation

We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces.

Conclusion

As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.

Cervicofacial Emphysema Complicating a Dental Procedure

BACKGROUND

Cervicofacial subcutaneous emphysema can occur rarely after a dental procedure, especially tooth extraction, and can be misdiagnosed as an allergic reaction or post-procedure swelling.

CASE REPORT

We report a rare case of a 29-year-old man who developed extensive cervicofacial subcutaneous emphysema after a dental hygiene procedure. A review of the relevant literature is presented in our report. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early identification and management of this potentially life-threatening condition is particularly important and can prevent serious complications, leading to improved patient outcomes.