Enfisema Subcutâneo e Pneumomediastino Durante uma Extração Dentária

Subcutaneous emphysema is a possible but infrequent consequence of dental procedures. We present the case of a 6-year-old healthy boy transferred from a dental clinic immediately after local anaesthesia for tooth extraction, due to sudden orbital and facial swelling. On physical examination, oedema of the left upper eyelid with fine crepitus on palpation and left hemiface oedema with local pain were observed. Ophthalmologic observation was normal. CT scan of the face and orbits documented extensive infiltration of the subcutaneous tissue planes of the left face by air, with extension to the external part of the body of the mandible, retromaxillary fat, masticatory muscle spaces, parapharyngeal space and adjacent to the orbital roof. After completing initial evaluation, the dentist confirmed the use of an air-driven device during local anaesthesia administration. The patient improved with conservative treatment. Early recognition of this condition is essential to provide an adequate clinical assessment with exclusion of possible life-threatening complications.

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Subcutaneous facial emphysema secondary to a dental procedure

Almeida

Faustino

Armindo

et al. 2021

BMJ Case Rep

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Subcutaneous emphysema during surgical gingival depigmentation: a case report

Attia,

Nabil,

Anis

2024

J Med Case Reports

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Background Subcutaneous emphysema related to dental procedures is well documented in literature. It usually occurs during or within minutes to hours after dental treatment and can be easily diagnosed by the presence of crepitus on palpation. Although it is self-limiting, it can develop to potentially life-threatening complications. Case presentation To the authors knowledge, this is the first report documenting the development of subcutaneous emphysema in a 22-year-old Egyptian female during lower surgical gingival depigmentation using NSK high speed, air driven handpiece operated at 0.25 MPa. Sudden swelling developed involving the right side of the face and immediate diagnosis of subcutaneous emphysema was made on the basis of the presence of crepitus during palpation of the swollen area. Intraoral examination revealed small tissue laceration of the loosely attached alveolar mucosa through which the pressurized air might have passed into the fascial spaces. Complete resolution of the swelling occurred after 7 days without further complications. Conclusion Straightforward surgical procedures, such as gingival depigmentation, can be complicated by the development of subcutaneous emphysema. The crucial role of dentists is to be aware of its signs and to immediately diagnose and manage it to avoid further complication.

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Pneumomediastinum and subcutaneous emphysema secondary to dental extraction: Two case reports

Ye¹,

Wang²,

Gao³

2022

WJCC

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BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain, swelling, and local infection. The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive. However, high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum, which is a serious iatrogenic complication. CASE SUMMARY We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction. The first case involved a 34-year-old man who complained of swelling of the face, mild chest tightness, and chest pain after dental extraction. Computed tomography (CT) scan showed a large amount of gas in the neck, chest wall, and mediastinum. The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction. CT showed a large amount of gas collected in the neck and mediastinum. Both of them used high-speed turbine splitting during dental extraction. CONCLUSION High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema. Dentists should carefully operate to avoid emphysema. If emphysema occurs, CT can be used to improve the diagnosis. The patient should be informed, and the complications dealt with carefully.

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Enfisema Subcutâneo e Pneumomediastino Durante uma Extração Dentária

Cited by 4 publications

References 7 publications

Subcutaneous facial emphysema secondary to a dental procedure

Subcutaneous facial emphysema secondary to a dental procedure

Subcutaneous emphysema during surgical gingival depigmentation: a case report

Pneumomediastinum and subcutaneous emphysema secondary to dental extraction: Two case reports

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