Pneumomediastinum and subcutaneous emphysema associated with temporomandibular joint surgery

Chuong, Robert; Boland, Thomas; Piper, Mark A.

doi:10.1016/0030-4220(92)90205-5

Cited by 23 publications

(13 citation statements)

References 33 publications

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“…However, there are reports in the oral surgical literature regarding SCE in which the high speed handpiece was used to section teeth prior to extraction (21,22), following trauma (23), or subsequent to temporomandibular joint surgery (24). It follows that caution should be exercised when exposing tissue during surgical procedures in order to avoid the introduction of compressed air along fascial planes.…”

Section: Subcutaneous Emphysemamentioning

confidence: 99%

Implications, prevention and management of subcutaneous emphysema during endodontic treatment

Battrum¹,

Gutmann²

1995

Dental Traumatology

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Battrum DE, Gutmann JL. Implications, prevention, an(d management of subcutaneous emphysema during endodontic treatment. Endod Dent Traumatol 1995; 11: 109^114. © Munksgaard, 1995.Abstract -Subcutaneous emphysema (SCE) is a possible complication of both nonsurgical and surgical endodontic treatment. A review of the literature pertinent to endodontic intervention and SCE is highlighted, while the causes of and recommendations for the prevention of SCE are provided. A review of the pathways whereby compressed air may travel through potential spaces in the head and neck is also illustrated in an attempt to identify the possibility' of morbidity and even mortality should operator induced SCE occur in a patient.

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Section: Subcutaneous Emphysemamentioning

confidence: 99%

Implications, prevention and management of subcutaneous emphysema during endodontic treatment

Battrum¹,

Gutmann²

1995

Dental Traumatology

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“…The first case of subcutaneous emphysema associated with a dental procedure was reported in 1900 by Turnbull [1], who referred to a case in which a bugle player, shortly after undergoing a tooth extraction, developed facial subcutaneous emphysema as a result of the Valsalva's manoeuvre while playing his instrument [2,3].…”

Section: Discussionmentioning

confidence: 98%

A strange chest pain after dental surgery

et al. 2008

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Case historyIn May 2007, a 29-year-old man was admitted to our ward complaining of chest pain exacerbated by deep breathing but not by change of position. The chest pain episodes were short-lasting (some minutes), but the patient complained of several relapses. Simultaneously, soft-consistency bilateral swelling of the neck appeared in the submandibular and lateral cervical regions.Ten hours before admission, the patient had undergone dental surgery for removal of the III right inferior wisdom tooth. The procedure was particularly difficult and lasted for more than 90 min.The family history was negative for cardiovascular disease; no relevant previous disease was present. He was not on any medical treatment; however, he smoked 15 cigarettes a day, and his alcohol intake was moderate.Physical examination of the patient showed normal blood pressure (120/80 mmHg) and heart rate (65 beats/ min). He was eupnoeic, and oxygen saturation of the blood was 97% (no oxygen supply). Body temperature was normal. A physical examinations showed bilateral swelling of subcutaneous tissues that were more pronounced on the right side of the neck, chest, and in the submandibular, lateral cervical, supraclavicular, and mammary regions, with modest pain and ''crepitation'' on digital pressure. The cardiac auscultation produced crackling, bubbling, and rubbing related to systole.The patient's white cell count was modestly elevated (11,100/mm 3 ), while the renal and liver functions and urinalysis were normal. No elevation of troponin I or T and of creatinine-phosphokinase was detected. The ECG showed the presence of sinus rhythm and high-voltage Twaves in peripheral leads. The chest X-ray examination showed no abnormal findings (Fig. 1). Based on these findings, a preliminary diagnosis of acute pericarditis was made. Differential diagnosisThe differential diagnosis in a patient with a combination of head and neck swelling, chest pain, and cardiac crackles includes the following: pneumothorax, oesophageal rupture, expanding haematoma, infection in the fascial planes, subcutaneous emphysema with pneumomediastinum, anaphylaxis, angioneurotic oedema, or other allergic reactions. Further investigationsThe patient underwent a neck/thorax CT scan (Figs. 2, 3) that demonstrated severe subcutaneous emphysema extending from the level of parapharingeal and submandibular spaces to the rest of the neck, to the jugular fossa, to the supraclavicular spaces, and to the retrosternal portion of the mediastinum. No pleural or parenchymal lesions were detected. An echocardiograph evaluation showed a normal ejection fraction and cardiac dimensions, and no signs of pulmonary hypertension or of pericarditis

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“…1 Mediastinal emphysema was first reported by Turnbull in 1900, and the most consistent feature in the aetiology of surgical emphysema related to dental practice is the use of compressed air powered instruments and this has been reported following restorative, 2 endodontic 3 and periodontal treatment, 4 extractions as well as more extensive surgical procedures involving the temporomandibular joint, 5 orthognathic surgery and facial fractures. 6,7 It is postulated that air is forced into the subcutaneous and fascial tissue planes and into the mediastinum.…”

Section: Discussionmentioning

confidence: 98%