Pneumatic dental extractions: an unusual cause of extensive cervical surgical emphysema

Abstract

A 50-year-old fit and well man presented to the Accident and Emergency Department in a tertiary centre following lower molar extraction, complaining of voice hoarseness with neck and facial swelling. Clinical examination along with plain film radiography revealed pneumomediastinum and extensive cervical surgical emphysema. He was subsequently admitted for observation and managed conservatively under the ENT team with input from the maxillofacial and anaesthetic teams. With supportive treatment only, the emphysema resolved and he remained well up until discharge.

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

“…Most patients will notice the presence of a swelling with subcutaneous crepitations; some may report neck pain, facial pain, chest pain, dyspnea, dysphagia, odynophagia, vocal hoarseness, or visual disturbance [ 8 , 10 , 18 ]. These different manifestations were observed in the 26 cases reported in the literature and are shown in Table 5 .…”

“…Diagnosis of subcutaneous emphysema is important because, if unnoticed, it can lead to various complications, such as pressure on the orbit, which can cause blindness [ 9 , 13 ], compression of the upper airway that sometimes requires intubation of the patient [ 1 , 3 , 14 ], and nerve compression (such as that of the recurrent laryngeal nerve) that causes vocal cord paresis [ 1 ]. Furthermore, subcutaneous emphysema may extend to the thorax, causing pneumopericardium [ 19 , 20 ] or pneumomediastinum [ 1 , 3 , 8 , 10 – 12 , 14 – 17 , 19 – 28 ]. Pressurized air can rupture the mediastinal pleura and cause pneumothorax [ 11 , 19 , 26 ].…”

“…Amoxicillin–clavulanic acid seems to be the most frequently used antibiotic treatment [ 17 ]. Some studies have suggested oxygen therapy to eliminate accumulated air more rapidly [ 10 – 12 , 19 , 24 ], whereas others have advised performing skin or chest drainage [ 1 , 8 , 13 ]. However, other reports have indicated that this may instead create a new entry point for air, worsening the situation [ 9 , 24 ].…”

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

“…The putative course of air entry in patients after tooth extraction is beneath the mucosa near the tonsillar fossa and the superior pharyngeal constrictor muscle, to the retropharyngeal space, and then down the carotid sheathes [ 11 ]. The most common symptoms reported by patients include dyspnea, cough, puffy face, subcutaneous emphysema, and retrosternal and back pain [ 12 ]. On physical examination, the Hamman sign can be detected [ 13 ] and is present in about half of the cases of mediastinal emphysema or left pneumothorax [ 14 ].…”

Extraction with an electric motor-driven handpiece may still cause subcutaneous emphysema - A case report

“…In severe cases, SE can spread and cause respiratory or cardiac distress. 3 However, most SE cases resolve within 3–5 days without complications.…”