Pneumothorax During Dental Care

Barkdull, Thad J.

doi:10.3122/jabfm.16.2.165

Cited by 22 publications

(7 citation statements)

References 18 publications

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“…[3–5] The development of deep soft tissue cervicofacial emphysema after dental treatment is a rare complication,[36] and most patients who develop subcutaneous emphysema after a dental procedure have only moderate local swelling. [3] In these cases, air dissection is probably caused by pressurized air being forced through the disrupted intraoral barrier (dentoalveolar membrane or root canal).…”

Section: Discussionmentioning

confidence: 99%

Dangerous space emphysema after dental treatment

Hagr

2010

Ann Thorac Med

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Section: Discussionmentioning

confidence: 99%

Dangerous space emphysema after dental treatment

Hagr

2010

Ann Thorac Med

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“…Complications of cervical emphysema and pneumomediastinum after oral surgery may include cardiac tamponade, airway obstruction, simple and tension pneumothorax and with pneumoperitoneum and secondary infective mediastinitis (in particular Pseudomonas Aeruginosa, Legionella Pneumophilia, Anaerobes, and Acanthamoeba) [14,15]. Ludwig's angina is a particular serious infectious complication that arises from bacterial spread through these fascial planes [16].…”

Section: Discussionmentioning

confidence: 99%

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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“…After 48 hours the facial swelling had reduced slightly and the symptoms were less severe. Stitches were removed a week after surgery and on examination the patient and sublingual area (5,6). The facial muscle buccinators, connecting the maxilla and the mandible, act as a guide for the air which follows the line of least resistance.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous emphysema resulting from surgical extraction without elevation of a mucoperiosteal skin flap

Peñarrocha¹,

Ata-Ali²,

Carrillo³

et al. 2011

J Clin Exp Dent

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Subcutaneous emphysema, is a rare occurrence in dental practice. It is usually benign and self-limiting; nevertheless, severe consequences can result from surgical treatment. Emphysema occurs when air is injected into the subcutaneous layer of the tissue, this may come from either an air turbine handpiece or air syringe. Due to the danger of developing emphysema, procedures using compressed air are not recommended in dental extractions involving the raising of a skin flap, bone sectioning or exeresis. Two determining factors are always involved with subcutaneous emphysema. On the one hand, a compressed air procedure (air turbine handpiece, air-water syringe), and on the other, a communication between the oral cavity and deeper tissue producing dissection. Early diagnosis and treatment are critical to prevent the trapped air leaking into other areas. The aim is to present a case of subcutaneous emphysema related to dental extraction, without raising a mucoperiosteal flap, possibly caused by close contact between the air turbine handpiece and the tooth during sectioning which forced air into the subcutaneous tissue.Key words: Subcutaneous emphysema, high pressure air instruments, dental procedure.Peñarrocha MA, Ata-Ali J, Carrillo C, Peñarrocha M. Subcutaneous emphysema resulting from surgical extraction without elevation of a mucoperiosteal skin flap. J Clin Exp Dent. 2011;3(3):e265-7.

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Pneumothorax During Dental Care

Cited by 22 publications

References 18 publications

Dangerous space emphysema after dental treatment

Dangerous space emphysema after dental treatment

A strange chest pain after dental surgery

Subcutaneous emphysema resulting from surgical extraction without elevation of a mucoperiosteal skin flap

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