Cervicofacial subcutaneous air emphysema after dental extraction

Article Abstract:

Subcutaneous air emphysema is a rare condition that results when air under pressure is forced into tissues where it is not normally present, such as in the face and neck. As it relates to a dental procedure, subcutaneous air emphysema has most often occurred after extraction of mandibular (lower) third molar teeth. Because this condition has varying degrees of severity and can require hospitalization, dentists should be able to diagnose it correctly. Sudden facial swelling during a procedure in which pressurized air is used, the sensation of air in the tissues, pain and crepitus (a crackling noise) are diagnostic features. X-ray confirmation can be obtained. The case history is presented of a young man who had a third molar removed and developed sensations of fullness in his cheek and, later, in the other side of his face and down his neck. He experienced shortness of breath, difficulty in swallowing, and inability to turn his head. Immediately after the extraction, the dentist had explained to the patient that his symptoms were due to air that had entered his face, but would resolve. However, the discomfort and difficulty breathing continued and the patient reported for emergency treatment several hours later. X-ray films showed extensive subcutaneous air emphysema in the neck and shoulders. Antibiotics were prescribed and the condition gradually abated during the next two weeks. Four causes of subcutaneous emphysema from dental procedures are considered: an action of the patient that would increase pressure to the site of a dental procedure (such as playing a bugle); use of compressed air during the procedure; difficult or lengthy extractions; and no apparent cause. In the case discussed, the type of dental handpiece selected was inappropriate for a procedure in which tissue flaps are lifted, as they must be during an extraction, since water and compressed air are delivered. Sudden swelling and crepitance are the main danger signs of subcutaneous air emphysema. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Orbital emphysema causing vision loss after a dental extraction

Article Abstract:

Subcutaneous emphysema of the face and neck is a condition in which air is forced into tissue spaces where it is not normally present. It usually results from facial trauma or the use of pneumatically cooled dental drills near open wounds. The case history is discussed of a young woman who developed subcutaneous emphysema after a dentist tried to remove a left lower molar with a high-speed air-cooled drill. She developed extensive emphysema in tissues of the face and around the eyes. The patient was ultimately left partially blind, with a visual field deficit and other symptoms. A sensation of facial discomfort and enlargement had begun during treatment, but was diagnosed as an allergic reaction. Allergy was again diagnosed when the patient visited an emergency room; the diagnosis was revised to subcutaneous emphysema when further tests were performed after her admission to the hospital. When sudden edema (swelling) occurs during a dental procedure, allergy should always be considered, but, in the absence of other acute allergy symptoms (such as heart or respiratory problems) subcutaneous emphysema should be considered. Crepitus (a crackling sound) and swelling are important diagnostic signs of subcutaneous emphysema. Careful attention by dental personnel to employ appropriate techniques and avoid this condition is essential. (Consumer Summary produced by Reliance Medical Information, Inc.)

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