Dental and Medical Problems
2019, vol. 56, nr 2, April-June, p. 203–207
doi: 10.17219/dmp/108615
Publication type: clinical case
Language: English
License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)
Download citation:
Cervicofacial and mediastinal emphysema after dental extraction
Odma szyjno-twarzowa oraz śródpiersia po usunięciu zęba
1 Department of Dental Sciences “G. Messina”, Faculty of Surgery, Oncology and Stomatology, University of Palermo, Italy
2 Department of Emergency Medicine, Civic Hospital of Palermo, Italy
Abstract
Subcutaneous emphysema (SE) is a rare but potentially life-threatening complication in dental procedures. The development of SE and pneumomediastinum (P) during tooth extraction is an uncommon complication. The roots of the second and third lower molars (and, rarely, of the premolar and first molar) communicate directly with the sublingual and submandibular spaces. Occasionally, after a dental operation, the pressurized air from the drill is forcefully injected into the surrounding subcutaneous tissues proximal to the extraction site in the facial planes. The air might pass through the sublingual and submandibular spaces to the pterygomandibular, parapharyngeal and retropharyngeal spaces, and to the mediastinum. Molar extraction is a common procedure in dental surgery. We report a rare case of extensive cervicofacial SE as well as P, following mandibular second molar extraction with the use of a high-speed dental handpiece, which is specifically designed for restorative treatment. Careful observations of the symptoms and clinical course, and an early initiation of pharmacologic therapy are recommended.
Key words
pneumomediastinum, subcutaneous emphysema, dental extraction
Słowa kluczowe
odma śródpiersia, odma podskórna, usunięcie zęba
References (12)
- Kim JP, Park JJ, Kang HS, Song MS. Subcutaneous emphysema and pneumomediastinum after tonsillectomy. Am J Otolaryngol. 2010;31(3):212–215.
- Iyer VN, Joshi AY, Ryu JH. Spontaneous pneumomediastinum: Analysis of 62 consecutive adult patients. Mayo Clin Proc. 2009;84(5):417–421.
- Kunkel M, Kleis W, Morbach T, Wagner W. Severe third molar complications including death-lessons from 100 cases requiring hospitalization. J Oral Maxillofac Surg. 2007;65(9):1700–1706.
- Nahlieli O, Neder A. Iatrogenic pneumomediastinum after endodontic therapy. Oral Surg Oral Med Oral Pathol. 1991;71(5):618–619.
- Davies DE. Pneumomediastinum after dental surgery. Anaesth Intensive Care. 2001;29(6):638–641.
- Smatt Y, Browaeys H, Genay A, Raoul G, Ferri J. Iatrogenic pneumomediastinum and facial emphysema after endodontic treatment. Br J Oral Maxillofac Surg. 2004;42(2):160–162.
- 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–e267.
- Chong VF, Fan YF. Radiology of the retropharyngeal space. Clin Radiol. 2000;55(10):740–748.
- Davis WL, Harnsberger HR, Smoker WR, Watanabe AS. Retropharyngeal space: Evaluation of normal anatomy and diseases with CT and MR imaging. Radiology. 1990;174(1):59–64.
- Scali F, Nash LG, Pontell ME. Defining the morphology and distribution of the alar fascia: A sheet plastination investigation. Ann Otol Rhinol Laryngol. 2015;124(10):814–819.
- Som PM, Curtin HD. Fascia and spaces of the neck. In: Som PM, Curtin HD, eds. Head and Neck Imaging. St. Louis, MO: Mosby; 2011:2203–2234.
- Yang SC, Chiu TH, Lin TJ, Chan HM. Subcutaneous emphysema and pneumomediastinum secondary to dental extraction: A case report and literature review. Kaohsiung J Med Sci. 2006;22(12):641–645.