Iatrogenic Subcutaneous Emphysema of Endodontic Origin – Case report with Literature Review

Abstract

Surgical emphysema is well known and many case reports have been published on this. Many authors have reported this as a complication post dentoalveolar treatment. Diffusion of air into facial planes and periorbital area during endodontic procedures has been rarely reported. The use of three way air syringe and forceful irrigation of root canal can lead to surgical emphysema of subcutaneous tissue planes in and around the teeth which are involved. This case report highlights one such complication seen during endodontic treatment, discusses aetiology, complications and conservative management of this dental office emergency.

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

“…The most commonly suspected cause was drying of the root canals by air under pressure. Although it has been recognized as a potential cause of SCE for several decades (Nehlsen 1927) this method appears to be still in use; six cases of SCE attributed to air-drying of root canals have been reported since 2000 (Smatt Table 3 Continued Summary of the management of SCE in the included cases 2004, Marmolejo & Molano-Valencia 2011, Al-Qudah et al 2013, Mishra et al 2014, Calzadilla et al 2018. Other frequently suspected causes were the inadvertent apical extrusion of oxygen produced during irrigation with hydrogen peroxide or of ozone gas used to disinfect the root canal.…”

“…, Mishra et al . ), the air‐water spray produced by dental handpieces and irrigation with hydrogen peroxide or its inadvertent extrusion through the apical foramen, have been considered as potential causes (Shovelton , Heyman & Babayof , McKenzie & Rosenberg ). However, due to the rare occurrence of this complication, the available evidence is limited to scattered case reports and a few case series , making it difficult to elucidate the factors that may affect its development.…”

“…Despite the fact that cases of SCE during root canal treatment have been reported for almost a century (Nehlsen 1927), its aetiology is not fully understood. Intense drying of root canals with air under pressure (Eleazer & Eleazer 1998, Bradford et al 2002, Mishra et al 2014, the air-water spray produced by dental handpieces and irrigation with hydrogen peroxide or its inadvertent extrusion through the apical foramen, have been considered as potential causes (Shovelton 1957, Heyman & Babayof 1995, McKenzie & Rosenberg 2009). However, due to the rare occurrence of this complication, the available evidence is limited to scattered case reports and a few case series, making it difficult to elucidate the factors that may affect its development.…”

Iatrogenic orbital, cervicofacial, and mediastinal emphysema through endodontic crestal perforation

“…SE is considered a rare complication of dental treatment and SE from endodontic treatment is even rarer. 4 , 5 In this case report, there was no communication between the root apex and the mandibular outer cortex ( Fig. 1 C and D) and the RCT was performed using the rubber dam.…”

Periorbital emphysema following dental procedure: A case report and literature review

“…Subcutaneous emphysema has been described as an infrequent complication of dental procedures performed in daily clinical practice. Specifically, the periorbital presentation of emphysema has been defined as an exceptional finding 2 . From the references published to date, there are only 13 cases describing periorbital involvement; ours is the 14 th literature reference.…”