Cervicofacial and mediastinal emphysema complicating tooth extraction in an elderly patient: a preventable complication

Abstract

Subcutaneous emphysema is widely documented in the literature and well known by doctors and dentists. However, subcutaneous emphysema following tooth extraction is not very common.We report the case of a 72-year-old female who presented to the emergency department of the Bunbury Hospital in Bunbury in the state of Western Australia in Australia, with subcutaneous emphysema of the face and neck with extension into the mediastinum, following a complicated tooth extraction in 2016. It was a dramatic and scary occurrence for both the patient and dentist, but totally preventable. The investigations and treatment could have been very invasive. However, with limited and essential management, the process was kept simple and safe for the patient.

A 39-Year-Old Woman with Cervicofacial and Mediastinal Emphysema 10 Hours After an Elective Lower Molar Dental Extraction

“…The maxillofacial surgeon on duty in our unit, despite nearly 20 years of work experience, had never encountered a similar case. Akra and Yousif [ 7 ] described a similar case in a patient who was more than twice as old as our patient. Their patient was sent home after the initial examination, but when odynophagia appeared, she presented again.…”

“…The first case report of subcutaneous emphysema after a dental procedure was described in 1900 [ 4 ]. Since then, cases of mediastinal emphysema have been described following various dental procedures, from standard hygiene procedures using air-driven dental handpieces to endodontic treatment [ 7 ]. Air-driven handpieces are a very well-known cause of subcutaneous emphysema.…”

“…No local or systemic infection occurred. In 2017, Akra and Yousif [ 7 ] reported a comparable case in a much older patient. A 72-year-old woman made an appointment with the dentist after a few days of toothache.…”