Orbital, Mediastinal, and Cervicofacial Subcutaneous Emphysema after Endodontic Retreatment of a Mandibular Premolar: A Case Report

An, Gregory K.; Zats, Boris; Kunin, Marc

doi:10.1016/j.joen.2013.09.042

Cited by 28 publications

(31 citation statements)

References 22 publications

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“…, An et al . ). Pneumomediastinum or mediastinal emphysema is a more serious condition than SCE; it involves the introduction of air into the mediastinum, the central compartment of the thoracic cavity (An et al .…”

Section: Resultsmentioning

confidence: 97%

“…, An et al . , Chang & Lien ). Moreover, none of the previous reviews has followed a systematic approach regarding the search, selection, critical appraisal and synthesis of the available evidence.…”

Section: Introductionmentioning

confidence: 97%

“…, An et al . , Mishra et al . ), the air‐water spray produced by dental handpieces and irrigation with hydrogen peroxide or its inadvertent extrusion through the apical foramen, have been considered as potential causes (Shovelton , Heyman & Babayof , McKenzie & Rosenberg ).…”

Section: Introductionmentioning

confidence: 99%

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Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

2019

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Background Subcutaneous emphysema is an infrequent mishap during root canal treatment which, in rare cases, can lead to severe complications. Aim To systematically review the literature on the factors affecting the development of subcutaneous emphysema during root canal treatment, and on its management. Data sources An electronic search was conducted in EMBASE (1947–2018), LILACS (1982–2018), PubMed (1950–2018), SciELO (1997–2018), Scopus (1970–2018), Web of Science (1900–2018) and two grey literature databases. Moreover, all issues of nine journals and four endodontic textbooks were hand‐searched. Study eligibility criteria, participants, interventions The retrieved studies were screened by two reviewers to select clinical studies, case reports or case series describing subcutaneous emphysema that developed during or immediately after root canal treatment in adult patients. Study appraisal and synthesis methods Included studies were critically appraised according to a custom list of quality requirements. The extracted data were arranged in tables, and combined through a narrative synthesis. Results The search retrieved 99 unique articles. Thirty six case reports and 15 case series describing a total of 65 cases of subcutaneous emphysema were included in this review. The methodological quality was medium. Reported cases of emphysema more often involved females and maxillary teeth. Drying of the root canal system with air under pressure, inadvertent extrusion of hydrogen peroxide through the apical foramen, the air‐water spray produced by handpieces or laser devices, and the use of ozone gas were the most commonly suspected causes. Its management involved prescription of antibiotics and NSAIDs/analgesics, local application of ice packs or compresses and hospitalization. The signs and symptoms resolved completely within 1‐17 days. Limitations Case reports and case series are a low level of evidence. Conclusions and implications of key findings Subcutaneous emphysema can develop during both nonsurgical and surgical root canal treatment. Pressurized air streams or air‐water sprays should not be directed towards the root canals or areas with mucosal discontinuity. None of the management approaches were clearly related to expedited recovery. Guidelines should be developed in order to avoid unnecessary or potentially harmful interventions.

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Section: Resultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

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Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

2019

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“…The differential diagnosis of emphysematous complaints includes allergic reactions, haematoma, cellulitis, and angioedema [13]. When the diagnosis is difficult, the best option is empirical treatment as for an anaphylactic reaction until a definitive diagnosis is possible [7]. Emphysema is sometimes detected the day after a procedure [14].…”

Section: Discussionmentioning

confidence: 99%

“…Complications include the need for tracheostomy or thoracic drainage, mediastinitis, an air embolism [2, 7, 11, 15, 16], pneumoperitoneum, pneumopericardium [17], and necrotising fasciitis [18]. Therefore, emphysema must be distinguished from gasses released by necrotising fasciitis with the help of serial CT imaging when necessary [7]. CT is the most useful imaging technique, affording excellent detail [5].…”

Section: Discussionmentioning

confidence: 99%

Massive Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum Developing during a Dental Hygiene Procedure

Bocchialini

Ambrosi

Castellani

2017

Case Reports in Dentistry

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Subcutaneous emphysema is rare during or after dental procedures (usually extractions). Here, we describe the case of a 65-year-old woman who developed massive cervicothoracic subcutaneous emphysema and pneumomediastinum during a dental hygiene procedure employing an artificial airflow. She was diagnosed based on clinical manifestations and computed tomography (CT). CT revealed massive subcutaneous emphysema extending from the superior left eyelid to the diaphragm. We describe the clinical and radiological characteristics of this rare case.

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Orbital, Mediastinal, and Cervicofacial Subcutaneous Emphysema after Endodontic Retreatment of a Mandibular Premolar: A Case Report

Cited by 28 publications

References 22 publications

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

Massive Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum Developing during a Dental Hygiene Procedure

Management of subcutaneous facial emphysema secondary to a class V dental restoration

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