Iatrogenic Subcutaneous Emphysema of Dental and Surgical Origin: A Literature Review

McKenzie, W.S.; Rosenberg, Morton

doi:10.1016/j.joms.2008.12.050

Cited by 150 publications

(201 citation statements)

References 23 publications

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“…It should be noticed that surgery is not the only procedure at risk for the development of subcutaneous emphysema, as cases have been described during restorative procedures, crown preparation, and endodontic therapy (4). emphysema has also been reported during oral laser surgery procedures (8).…”

Section: Discussionmentioning

confidence: 99%

“…Once under the dermal layer, the air may remain locally at the surgical site or continue to spread along the loose connective tissue plane. The clinical results are local swelling, tenting of the skin and crepitation on palpation (4). In extreme cases, air could pass through the masticatory space into the parapharyngeal and retropharyngeal areas, penetrating into the mediastinum (3).…”

Section: Introductionmentioning

confidence: 99%

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Subcutaneous emphysema during third molar surgery: a case report

Romeo¹,

Galanakis²,

Lerario³

et al. 2011

Braz. Dent. J.

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extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.key Words: subcutaneous emphysema, third molar extraction, high pressure air instruments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subcutaneous emphysema during third molar surgery: a case report

Romeo¹,

Galanakis²,

Lerario³

et al. 2011

Braz. Dent. J.

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“…The etiology of cervicofacial emphysema is divided into three categories: Spontaneous which is induced by the patient while coughing [10], secondary after trauma to facial skeleton [11] and iatrogenic after a surgical procedure when air is introduced into the soft tissues [3]. The clinical diagnosis of cervicofacial emphysema is based upon the sudden onset of swelling with crepitation in the absence of erythema, edema, significant tenderness or lymphadenopathy.…”

Section: Discussionmentioning

confidence: 99%

“…It is mainly caused by trauma, head and neck surgery, general anaesthesia [1], and rarely by dental treatment [2]. A comprehensive search of the medical and dental literature from 1993 to 2008 yielded 32 case reports of subcutaneous emphysema due to dental operations [3]. Shovelton in 1957 reported 13 such cases after endodontic treatment [4].…”

Section: Introductionmentioning

confidence: 99%

CT Assisted Diagnosis, Management of Soft Tissue Cervicofacial Emphysema and Pneumomediastinum during Root Canal Treatment of an Upper Premolar: A Case Report

Narang¹

2015

Oral Hyg Health

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Aim:To discuss the iatrogenic cervicofacial emphysema and pneumomediastinum after endodontic treatment of maxillary premolar. Summary:A 25-year-old female was referred to the department with considerable swelling on the right side of face. She gave a history of progressive swelling with mild difficulty in breathing and swallowing 15 minutes after endodontic treatment of an upper right first premolar. The tooth was accessed by a private practitioner using high speed air driven handpiece without the use of rubber dam and compressed air was used to dry the canals. On examination, swelling extended from right peri-orbital region to the neck bilaterally. It was soft, non-erythematous and showed crepitations without pain. The microbiological tests showed no evidence of infection. A Computed tomogram of the thoracocervicofacial region confirmed the diagnosis of cervicofacial emphysema with pneumomediastinum. She was kept on antibiotics and analgesics for 7 and 3 days respectively. Patient showed regression of swelling, dyspnoea and dysphagia on follow up visit after 48 hours.Key learning point:Early diagnosis and management of such cases is of extreme importance to prevent possible cardiopulmonary complications and infections. Computed tomography scans are very useful in diagnosis and to determine the extension of air into the tissue spaces.

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“…De nombreux cas sont rapportés [4]. Des complications gravissimes lui sont souvent imputées mais une revue exhaustive de la littérature ne permet pas de retrouver de morbidité significative ou de mortalité liées à un ESC.…”

Section: Emphysème Sous-cutané [4]unclassified

Tuméfactions cervico-faciales per et post-opératoires immédiates en chirurgie bucco-dentaire

Calon

Schellenberger

Gros

et al. 2013

Med Buccale Chir Buccale

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Résumé -Il n'est pas rare que le chirurgien-dentiste soit confronté à une tuméfaction cervico-faciale (TCF) per ou post-opératoire immédiate. Bien qu'il s'agisse généralement d'un phénomène bénin, il est souvent source d'inquié-tude pour le praticien et le patient. Une revue de littérature se propose de présenter les différentes étiologies de tuméfactions cervico-faciales per et post-opératoires, et d'apporter les éléments pratiques pour leur diagnostic. Parmi ces tuméfactions, l'emphysème sous-cutané est un évènement banal, bénin et facile à diagnostiquer mais souvent méconnu, ce dont témoigne le nombre de cas rapportés. Plus rares, mais potentiellement graves, il convient également de citer l'hématome du plancher buccal et l'angioedème qui peuvent être la conséquence du geste bucco-dentaire ou des médicaments. Dans ce cadre, il est en effet nécessaire de savoir reconnaître les prodromes d'une détresse respiratoire. Enfin, la fasciite nécrosante cervico-faciale se doit d'être reconnue tôt du fait de son extrême gravité, d'autant que son incidence paraît croissante. Un tableau récapitulatif présente les principales causes de TCF per et post-opératoires après chirurgie dentaire, leur chronologie, leurs principaux symptômes et les mesures thérapeutiques à mettre en oeuvre.Abstract -Cervicofacial swelling after dental treatment: what the dentist should know. Although generally harmless, the occurrence of cervicofacial swelling (CFS) during or after dental surgery can be worrisome for the dentist or the patient. This article is a literature review of most causes of CFS after dental surgery. Practical diagnosis tools should allow distinguishing between benign and dangerous situations. Indeed, the occurrence of a spectacular but harmless condition like subcutaneous emphysema may cause unnecessary concern, as witnessed by the many case reports in medical literature. On the other hand, conditions like hematoma of the floor of the mouth or angioedema may be caused by the dentist (through surgery or medication) and can become lifethreatening. Upper airway compromise should be recognized early on. Cervical fasciitis (CF) is a severe and often fulminating septic emergency with potentially dramatic consequences, warranting immediate intensive and surgical care. The increasing incidence of CF and its possible occurrence after dental surgery warrants a high level of suspicion in a septic patient. Finally, a summary chart will point out the time course, symptoms and management of the different causes of CFS after dental surgery.Lors d'un acte de chirurgie bucco-dentaire ou dans son décours immédiat, la survenue d'une tuméfaction cervicofaciale (TCF) n'est pas rare. Si elle présente généralement un aspect bénin (bien qu'inquiétant parfois pour le praticien ou le patient), elle peut en de rares occasions, nécessiter une prise en charge spécifique. Le but de ce travail était de faire une revue synthétique des éléments cliniques associés aux

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Iatrogenic Subcutaneous Emphysema of Dental and Surgical Origin: A Literature Review

Cited by 150 publications

References 23 publications

Subcutaneous emphysema during third molar surgery: a case report

Subcutaneous emphysema during third molar surgery: a case report

CT Assisted Diagnosis, Management of Soft Tissue Cervicofacial Emphysema and Pneumomediastinum during Root Canal Treatment of an Upper Premolar: A Case Report

Tuméfactions cervico-faciales per et post-opératoires immédiates en chirurgie bucco-dentaire

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