Subcutaneous emphysema secondary to dental extraction: A case report

Abstract

Although less frequently encountered in dental practices, subcutaneous emphysema of the face and neck has been reported in patients following dental extractions, particularly when lower molar teeth are extracted with the use of a high-speed air-turbine drill designed for restorative treatment, which forces air into the cervical fascial spaces. As facial swelling and pain are the most common presentations, subcutaneous emphysema can often be misdiagnosed as an allergic reaction or odontogenic infection. While usually a benign and self-limiting condition, subcutaneous emphysema may have life-threatening complications such as tension pneumothorax, cardiac tamponade, air embolism, tracheal compression and mediastinitis, which are important to recognize in an emergency setting. Dentists should be aware of the serious risks of inducing subcutaneous emphysema and avoid performing tooth extractions with high-speed air-turbine drills which are specifically designed for use for restorative treatments only.

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

“…Involvement of the parapharyngeal spaces may result in tracheal compression in severe cases. Pneumomediastinum may result in venous distension, hypotension, hypocarbia, and acidosis …”

“…The diagnosis of SFE for this patient was confirmed clinically and radiographically, and broad‐spectrum antibiotic therapy was commenced to reduce the risk of complications such as necrotizing fasciitis, which may arise from nonsterile air containing oral microbes being introduced into the fascial spaces . Air is typically absorbed by tissues over time, and the condition usually begins to resolve within 2‐3 days with most cases showing complete resolution clinically and radiographically by 7‐10 days . The lack of airway compromise and cardiorespiratory symptoms in this patient precluded the need for more extensive imaging and enabled conservative management with antibiotic treatment, oral analgesics, patient reassurance, and frequent review.…”

“…Differential diagnoses for swelling of rapid onset during or after dental treatment include hypersensitivity reaction, hematoma, cellulitis, necrotizing fasciitis, angioedema, and subcutaneous facial emphysema . In cases of subcutaneous facial emphysema, signs of swelling may occur immediately or within minutes to hours after a procedure .…”

“…The use of polytetrafluoroethylene (PTFE) tape has been suggested as a gentler alternative to conventional retraction cords during class V restorative treatment. Alternatives to tissue retraction such as laser surgery, electrosurgery, and ceramic tissue trimmers have also been suggested to reduce risk of SFE where their use is appropriate . Rubber dam isolation with appropriate root clamps is another preventive measure which may act as a physical barrier to air entering the gingival sulcus .…”

Rare mediastinal complications of dental procedures

“…Dental extraction is a frequent procedure that has the potential to cause lethal complications if not performed under appropriate conditions. Complications encountered after dental extraction range in a variety of disorders including head and neck emphysema, pneumomediastinum, pharyngeal abscess, septic thrombophlebitis of internal jugular vein, mediastinitis and mediastinal abscess, peribronchovascular inflammation in the lung parenchyma, and septicemia [1][2][3][4]. Pneumomediastinum, which is defined as entrapment of free air in the mediastinal space, was first described by Laënnec in 1819 [5].…”