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Sarfi D, Haitami S, Farouk M, Ben Yahya I. Subcutaneous emphysema during mandibular wisdom tooth extraction: Cases series. Ann Med Surg (Lond) 2021; 72:103039. [PMID: 34815859 PMCID: PMC8591463 DOI: 10.1016/j.amsu.2021.103039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
Subcutaneous emphysema occurs when air is forced under the tissue, causing swelling, crepitus on palpation, and the possibility of spreading along the fascial planes. Although subcutaneous emphysema secondary to dental procedures is rare, it can be a potentially fatal complication if not diagnosed and treated promptly and correctly. Dentists need to be able to differentiate subcutaneous emphysemas from more common disease processes that have similar clinical presentations. We report a 22-year-old male who underwent mandibular wisdom tooth extraction and subsequently developed extensive subcutaneous emphysema. The patient was quickly taken care of, in partnership with the maxillofacial department. The purpose of this report is to bring attention to the fact that obtaining an accurate diagnosis for this condition is very important and management on time can prevent serious complications.
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Affiliation(s)
- D Sarfi
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, BP, 9157, Morocco
| | - S Haitami
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, BP, 9157, Morocco
| | - M Farouk
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, BP, 9157, Morocco
| | - I Ben Yahya
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, BP, 9157, Morocco
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2
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Jones A, Stagnell S, Renton T, Aggarwal VR, Moore R. Causes of subcutaneous emphysema following dental procedures: a systematic review of cases 1993-2020. Br Dent J 2021; 231:493-500. [PMID: 34686817 DOI: 10.1038/s41415-021-3564-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022]
Abstract
Objectives Causes of subcutaneous emphysema (SE) following dental treatment have changed with new operative techniques and equipment. This review demonstrates the frequency and aetiology of SE to inform prevention strategies for reducing SE occurrences.Methods A systematic search of Medline, Embase and PubMed databases identified 135 cases of SE which met inclusion criteria after independent review by two authors. Trends in frequency and causes of SE were displayed graphically and significant differences in frequency of SE by time period, site and hospital stay were analysed using t-tests.Results Dental extractions often preceded development of SE (54% of cases), commonly surgical extractions. Treatment of posterior mandibular teeth most often resulted in development of SE. Most cases were iatrogenic, with 51% resulting from an air-driven handpiece and 9% from air syringes. Factors such as nose blowing accounted for 10%. There was a significant (p <0.05) increase in cases over time. Mandibular teeth had increased hospital stay time compared to maxillary teeth (p <0.01).Conclusion Increased risks of SE were identified following use of air-driven handpieces during dental extractions and when treating lower molar teeth. Use of air-driven handpieces should be avoided during dental extractions to reduce risks and subsequent morbidity that results from SE.
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Affiliation(s)
- Adam Jones
- Department of Oral Surgery, University of Leeds, UK.
| | | | - Tara Renton
- Department of Oral Surgery, King´s College London, UK
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3
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Brzycki RM. Case Report: Subcutaneous Emphysema and Pneumomediastinum Following Dental Extraction. Clin Pract Cases Emerg Med 2021; 5:58-61. [PMID: 33560953 PMCID: PMC7872623 DOI: 10.5811/cpcem.2020.9.49208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/18/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Emergency physicians should be cognizant of complications following common procedures (including dental) and be able to readily care for patients with acute dental pain. Case Report A 22-year-old female presented with dental pain and difficulty swallowing that developed 48 hours after she underwent a dental extraction. The physical exam showed an uncomfortable, afebrile female with dysphonia, inability to tolerate secretions, and crepitus over the neck and anterior chest wall. Discussion The use of a high-speed dental drill may have caused air to dissect through fascial planes leading to subcutaneous emphysema, or even through deeper planes resulting in pneumomediastinum. It should be noted that subcutaneous emphysema and pneumomediastinum are rare complications of dental procedures. Conclusion This case highlights an uncommon but potentially life-threatening complication following a routine dental procedure, which emergency clinicians should be attentive to and able to identify and thereby manage.
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Affiliation(s)
- Ryan M Brzycki
- Mercy St. Vincent Medical Center, Department of Emergency Medicine, Toledo, Ohio
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4
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Busuladzic A, Patry M, Fradet L, Turgeon V, Bussieres M. Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature. J Otolaryngol Head Neck Surg 2020; 49:61. [PMID: 32811562 PMCID: PMC7433085 DOI: 10.1186/s40463-020-00455-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections. Case presentation We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces. Conclusion As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.
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Affiliation(s)
- Adnan Busuladzic
- Université de Sherbrooke, 580 Bowen Sud, Sherbrooke, QC, J1G 2E8, Canada
| | - Melissa Patry
- Université de Sherbrooke, 580 Bowen Sud, Sherbrooke, QC, J1G 2E8, Canada
| | - Laurent Fradet
- Université de Sherbrooke, 580 Bowen Sud, Sherbrooke, QC, J1G 2E8, Canada
| | - Valérie Turgeon
- Clinique Dentaire du Carrefour, 2910, boul. Portland, Sherbrooke, QC, J1L 1R8, Canada
| | - Marie Bussieres
- Université de Sherbrooke, 580 Bowen Sud, Sherbrooke, QC, J1G 2E8, Canada.
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5
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Dodge A, Kreh K, Kofina V, Rawal SY. Sublingual emphysema following alveoloplasty: A case report. Clin Case Rep 2020; 8:2051-2054. [PMID: 33088550 PMCID: PMC7562880 DOI: 10.1002/ccr3.3106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 11/19/2022] Open
Abstract
Various cases of introduction of air into soft tissues have been reported in the dental literature. Here, we report a rare case of localized sublingual emphysema after alveoloplasty. There was no facial involvement. The patient responded to treatment and recovered uneventfully.
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Affiliation(s)
- Austin Dodge
- Marquette University School of Dentistry Milwaukee WI USA
| | - Katelyn Kreh
- Marquette University School of Dentistry Milwaukee WI USA
| | - Vrisiis Kofina
- Marquette University School of Dentistry Milwaukee WI USA
| | - Swati Y Rawal
- Marquette University School of Dentistry Milwaukee WI USA
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6
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Kaufmann ME, Solderer A, Hofer D, Schmidlin PR. The Strange Case of a Broken Periodontal Instrument Tip. Dent J (Basel) 2020; 8:dj8020055. [PMID: 32503214 PMCID: PMC7345799 DOI: 10.3390/dj8020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
Abstract
This case report describes a rare case of a broken periodontal probe tip and its removal. A male patient presented himself in June 2019 due to a painful tooth in the upper left quadrant. The patient elected treatment in the dental school’s student course. In October 2019, in preparation for full-mouth rehabilitation, a complete diagnostic status was performed, including radiographs. In this context, a metal-dense fragment was identified in the apical region of the (missing) tooth 45. It was diagnosed as the broken tip of a periodontal probe (type AE P OWB). Since a PCP-12 probe is generally used in-house, iatrogenic damage during the initial examination or student course could be excluded a priori. The patient was not able to remember any treatment that could be associated with the instrument’s breaking. Since the probe fragment was palpable and a translocation could not be precluded, the patient agreed to its removal under local anesthesia, after a cone-beam CT. This article describes and discusses this particular case, with special emphasis on iatrogenic instrument fractures and their removal.
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7
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Abstract
Periorbital and subcutaneous emphysema after transnasal endoscopic surgery are rare. Periorbital emphysema has been reported after facial trauma, dental interventions, procedures such as endoscopic sinus surgery and rhinoplasty, and due to medications such as systemic steroids. Although very rare, it may require urgent intervention because of the risk of increased intraocular pressure and impaired blood supply to the globe. The otolaryngology department requested ophthalmology consultation for a 65-year-old male patient who had severe periorbital emphysema of the right eye the day after endoscopic nasal polypectomy due to severe coughing and straining. Crepitus was detected on skin palpation and immediate intervention was performed by passing a 21-gauge needle through the skin into the subcutaneous tissue of the upper and lower eyelids to evacuate the subcutaneous air. The patient’s clinical symptoms resolved with no postoperative complications.
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Affiliation(s)
- Esat Çınar
- Ekol Eye Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Berna Yüce
- İzmir University of Health Sciences, Tepecik Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Murat Fece
- Ekol Eye Hospital, Ophthalmology Clinic, İzmir, Turkey
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8
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Chien PYH. Iatrogenic subcutaneous facial emphysema secondary to a Class V dental restoration: a case report. Aust Dent J 2018; 64:43-46. [PMID: 30276816 DOI: 10.1111/adj.12657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 11/26/2022]
Abstract
Subcutaneous facial emphysema (SFE) following routine dental operative procedure is an uncommon but potentially life-threatening complication. The present case details a Class V restoration where air was introduced into the fascial tissue planes via the gingival sulcus from the use of an air-driven dental handpiece. Although the SFE is usually self-limiting within 3-10 days, such instances should be regarded as a medical emergency as in severe cases, the air may spread to the neck, mediastinum and thorax to result in cervicofacial emphysema with potential pneumomediastinum and pneumothorax.
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Affiliation(s)
- P Y H Chien
- The University of Queensland (UQ), Wide Bay Hospital and Health Services (WBHHS), Brisbane, Queensland, Australia
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9
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Rajaran JR, Nazimi AJ, Rajandram RK. Iatrogenic displacement of high-speed bur during third molar removal. BMJ Case Rep 2017; 2017:bcr-2017-221892. [PMID: 28954756 DOI: 10.1136/bcr-2017-221892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Surgical removal of impacted mandibular third molar is a routine procedure in oral surgery. Various iatrogenic complications related to the procedure has been discussed well in the literatures before. Some of these complications are related to the wrong usage of instruments and techniques. Here we discuss a rare complication on a 42-year-old male, related to the use of high-speed handpiece drill in mandibular third molar removal in a general dental office setting. He was referred when a high speed tungsten carbide bur was accidentally broken and displaced into the mandibular bone during surgical procedure. It is not common to use a high-speed handpiece in impacted third molar removal. This iatrogenic complication could have been totally avoided with the use of proper equipment and technique; therefore raising awareness regarding wrong usage of instrument is vital to avoid similar incidents in the future.
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Affiliation(s)
- Jothi Raamahlingam Rajaran
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry UKM and UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Abd Jabar Nazimi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry UKM and UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Rama Krsna Rajandram
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry UKM and UKM Medical Centre, Kuala Lumpur, Malaysia
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10
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Massive Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum Developing during a Dental Hygiene Procedure. Case Rep Dent 2017; 2017:7016467. [PMID: 28487779 PMCID: PMC5406744 DOI: 10.1155/2017/7016467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/29/2017] [Accepted: 04/10/2017] [Indexed: 11/17/2022] Open
Abstract
Subcutaneous emphysema is rare during or after dental procedures (usually extractions). Here, we describe the case of a 65-year-old woman who developed massive cervicothoracic subcutaneous emphysema and pneumomediastinum during a dental hygiene procedure employing an artificial airflow. She was diagnosed based on clinical manifestations and computed tomography (CT). CT revealed massive subcutaneous emphysema extending from the superior left eyelid to the diaphragm. We describe the clinical and radiological characteristics of this rare case.
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11
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Lee SW, Huh YH, Cha MS. Iatrogenic subcutaneous cervicofacial emphysema with pneumomediastinum after class V restoration. J Korean Assoc Oral Maxillofac Surg 2017; 43:49-52. [PMID: 28280711 PMCID: PMC5342974 DOI: 10.5125/jkaoms.2017.43.1.49] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/18/2016] [Accepted: 11/30/2016] [Indexed: 11/07/2022] Open
Abstract
Subcutaneous facial emphysema after dental treatment is an uncommon complication caused by the invasion of high-pressure air; in severe cases, it can spread to the neck, mediastinum, and thorax, resulting in cervical emphysema, pneumomediastinum, and pneumothorax. The present case showed subcutaneous cervicofacial emphysema with pneumomediastinum after class V restoration. The patient was fully recovered after eight days of conservative treatment. The cause of this case was the penetration of high-pressure air through the gingival sulcus, which had a weakened gingival attachment. This case indicated that dentists should be careful to prevent subcutaneous emphysema during common dental treatments using a high-speed hand piece and gingival retraction cord.
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Affiliation(s)
- Sang-Woon Lee
- Department of Dentistry, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yoon-Hyuk Huh
- Department of Prosthodontics and Research Institute of Oral Science, Gangneung-Wonju National University, Gangneung, Korea
| | - Min-Sang Cha
- Department of Dentistry, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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12
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Hals- und Gesichtsschwellung nach einem Zahnarztbesuch. HNO 2016; 64:759-62. [DOI: 10.1007/s00106-016-0210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Sakakibara A, Suzuki H, Yamashita A, Hasegawa T, Minamikawa T, Furudoi S, Komori T. Facial emphysema after sinus lift. J Surg Case Rep 2015; 2015:rjv067. [PMID: 26088054 PMCID: PMC4471490 DOI: 10.1093/jscr/rjv067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An 80-year-old man with a history of en bloc resection of squamous cell carcinoma of the hard palate (T4aN0M0) was performed a lateral-window sinus lift of the edentulous area of the left maxillary molar region to facilitate future placement of dental implants. Two hours after the surgery, the patient complained of sudden malar swelling. Marked swelling was present from the left infraorbital region to the buccal region. The swelling was associated with air pockets at the alar base and in the angulus oculi medialis region and subcutaneous malar tissue. Emphysema appeared after the patient blew his nose. Therefore, the mucous membrane of the maxillary sinus might have had a small hole, and air might have entered the subcutaneous tissue via the bone window when the air pressure in the maxillary sinus increased with nose blowing. It is important to advise patients to avoid increasing the intraoral pressure after sinus-lift procedure.
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Affiliation(s)
- Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Suzuki
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuya Yamashita
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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14
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Tomasetti P, Kuttenberger J, Bassetti R. Distinct subcutaneous emphysema following surgical wisdom tooth extraction in a patient suffering from 'Gilles de la Tourette syndrome'. J Surg Case Rep 2015; 2015:rjv068. [PMID: 26077530 PMCID: PMC4466419 DOI: 10.1093/jscr/rjv068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Subcutaneous emphysema is a rare complication in oral surgery. In most cases, it resolves spontaneously. However, air might disperse into deeper facial spaces causing life-threatening complications such as compression of the tracheobronchial tree or the development of pneumomediastinum. Moreover, microorganisms might spread from the oral cavity into deeper spaces. Hence, rapid diagnosis of subcutaneous emphysema is important. Characteristic signs are both a shiftable swelling and crepitation. In this case report, a 30-year-old man, suffering from the Gilles de la Tourette Syndrome, with a distinct subcutaneous emphysema after bilateral surgical wisdom tooth extraction is presented. Induced by a specific motor tic, air accumulated from the periorbital through to the parapharyngeal region. Applying a 10-cm-long Redon drainage tube as air valve, 10 days after wisdom teeth extraction, the patient was asymptomatic with complete resolution of the emphysema.
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Affiliation(s)
- Patrick Tomasetti
- Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Johannes Kuttenberger
- Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Renzo Bassetti
- Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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15
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Wong C, Collin J, Hughes C, Thomas S. Surgical emphysema and pneumomediastinum after coronectomy. Br J Oral Maxillofac Surg 2015; 53:763-4. [PMID: 26050131 DOI: 10.1016/j.bjoms.2015.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
Abstract
We report a case of surgical emphysema and pneumomediastinum after coronectomy of the lower right third molar. Surgical emphysema related to dental extractions is well- reported, but not after coronectomy. This case emphasises the importance of avoiding the use of air turbine drills during oral surgery.
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Affiliation(s)
- C Wong
- Rooftop Offices, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS2 1LY, United Kingdom.
| | - J Collin
- Rooftop Offices, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS2 1LY, United Kingdom.
| | - C Hughes
- Rooftop Offices, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS2 1LY, United Kingdom.
| | - S Thomas
- Rooftop Offices, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS2 1LY, United Kingdom.
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16
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Aslaner MA, Kasap GN, Demir C, Akkaş M, Aksu NM. Occurrence of pneumomediastinum due to dental procedures. Am J Emerg Med 2014; 33:125.e1-3. [PMID: 25027199 DOI: 10.1016/j.ajem.2014.05.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 11/15/2022] Open
Abstract
The occurrence of pneumomediastinum and massive subcutaneous emphysema due to dental procedures is quite rare. We present a case of pneumomediastinum and massive subcutaneous emphysema that occurred during third molar tooth extraction with air-turbine handpiece.
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Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency Medicine, Hacettepe University, Medical School, Ankara, Turkey.
| | - Gül Nihal Kasap
- Department of Emergency Medicine, Hacettepe University, Medical School, Ankara, Turkey
| | - Cihat Demir
- Department of Emergency Medicine, Hacettepe University, Medical School, Ankara, Turkey
| | - Meltem Akkaş
- Department of Emergency Medicine, Hacettepe University, Medical School, Ankara, Turkey
| | - Nalan M Aksu
- Department of Emergency Medicine, Hacettepe University, Medical School, Ankara, Turkey
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17
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Orbital, mediastinal, and cervicofacial subcutaneous emphysema after endodontic retreatment of a mandibular premolar: a case report. J Endod 2013; 40:880-3. [PMID: 24862722 DOI: 10.1016/j.joen.2013.09.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/30/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Subcutaneous emphysema (SCE) rarely occurs from endodontic treatment. Most reported cases of iatrogenic SCE occur in the cervicofacial region. Only a few cases have been reported of SCE extending into the mediastinum or orbital spaces. In the present report, we describe a concomitant occurrence of orbital, mediastinal, and cervicofacial SCE immediately after endodontic retreatment. METHODS A 33-year-old woman presented to the hospital with acute swelling of the right side of her face and neck. Earlier in the day, she began experiencing rapid swelling while undergoing endodontic retreatment of a mandibular right first premolar by her general dentist. The dentist immediately referred the case to an oral surgeon who then ordered additional tests and radiographic studies at the hospital. From there, the patient received consultation and comprehensive treatment by a multidisciplinary team of medical and dental staff. RESULTS Physical examination, laboratory tests, and computed tomographic studies confirmed a diagnosis of SCE. Extensive air pockets were detected within the orbital, mediastinum, and cervicofacial spaces. The patient was admitted to the hospital and underwent treatment and observation for massive SCE with likely secondary infection. On the fifth day, she was discharged after showing dramatic improvement. CONCLUSIONS SCE may go undetected or misdiagnosed. Complications may be fatal. Therefore, clinicians should apply preventive measures and know how to identify and manage SCE. We review reports of SCE in the last century, discuss etiology and differential diagnosis, and present recommendations for prevention and management of SCE.
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18
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Khandelwal V, Agrawal P, Agrawal D, Nayak PA. Subcutaneous emphysema of periorbital region after stainless steel crown preparation in a young child. BMJ Case Rep 2013; 2013:bcr2013009952. [PMID: 23704466 PMCID: PMC3670076 DOI: 10.1136/bcr-2013-009952] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Subcutaneous emphysema occurs when air is forced beneath the tissue, leading to swelling, crepitus on palpation and has the potential to spread along the fascial planes. This report describes the youngest case of subcutaneous emphysema related to dental treatment that has been documented to date. In addition to the patient's age, the case is of interest because periorbital subcutaneous emphysema is a rarest complication of stainless steel crown procedure.
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Affiliation(s)
- Vishal Khandelwal
- Department of Pedodontics, Modern Dental College and Research Center, Indore, Madhya Pradesh,India
| | | | - Deepak Agrawal
- Department of Oral & Maxillo-facial Surgery, Government College of Dentistry, Indore, Madhya Pradesh, India
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19
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Cervicofacial Emphysema After Dental Treatment With Emphasis on the Anatomy of the Cervical Fascia. J Craniofac Surg 2012; 23:e544-8. [DOI: 10.1097/scs.0b013e31825aef02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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20
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Romeo U, Galanakis A, Lerario F, Daniele GM, Tenore G, Palaia G. Subcutaneous emphysema during third molar surgery: a case report. Braz Dent J 2011; 22:83-6. [PMID: 21519655 DOI: 10.1590/s0103-64402011000100015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Umberto Romeo
- Department of Oral Sciences, Sapienza, University of Rome, Italy.
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21
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Henderson SJ. Risk management in clinical practice. Part 11. Oral surgery. Br Dent J 2011; 210:17-23. [DOI: 10.1038/sj.bdj.2010.1182] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2010] [Indexed: 11/09/2022]
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22
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Kim Y, Kim MR, Kim SJ. Iatrogenic pneumomediastinum with extensive subcutaneous emphysema after endodontic treatment: report of 2 cases. ACTA ACUST UNITED AC 2009; 109:e114-9. [PMID: 19969477 DOI: 10.1016/j.tripleo.2009.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 09/11/2009] [Indexed: 10/20/2022]
Abstract
Pneumomediastinum with subcutaneous emphysema is a relatively rare complication of dental treatment. The most common dental etiology of this complication is the introduction of air via the air-turbine handpiece during surgical extraction of an impacted tooth, but this complication is very rare after nonsurgical endodontic treatment. We report herein 2 cases of massive pneumomediastinum and cervicofacial subcutaneous emphysema that developed after opening an access cavity for endodontic retreatment. We describe its etiologies and guidelines for the prevention of this complication during nonsurgical endodontic treatment.
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Affiliation(s)
- Yemi Kim
- Department of Endodontics, Graduate School of Medicine, Ewha Womans University, Seoul, Korea
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Iatrogenic Subcutaneous Emphysema of Dental and Surgical Origin: A Literature Review. J Oral Maxillofac Surg 2009; 67:1265-8. [DOI: 10.1016/j.joms.2008.12.050] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/13/2008] [Accepted: 12/18/2008] [Indexed: 01/09/2023]
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24
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Arai I, Aoki T, Yamazaki H, Ota Y, Kaneko A. Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report. ACTA ACUST UNITED AC 2009; 107:e33-8. [DOI: 10.1016/j.tripleo.2008.12.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 10/15/2008] [Accepted: 12/08/2008] [Indexed: 11/29/2022]
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25
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Rehman KU, Monaghan AM, Tong JL. Air penetration into the tissues during oral surgery. Anesth Analg 2008; 107:1085; author reply 1085. [PMID: 18713939 DOI: 10.1213/ane.0b013e31818259c2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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26
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Greenstein G, Cavallaro J, Romanos G, Tarnow D. Clinical Recommendations for Avoiding and Managing Surgical Complications Associated With Implant Dentistry: A Review. J Periodontol 2008; 79:1317-29. [DOI: 10.1902/jop.2008.070067] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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27
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Porteri E, Rizzardi N, Rizzoni D, Salvi A, De Ciuceis C, Farina D, Boari GEM, Platto C, Paiardi S, Raed A, Rosei EA. A strange chest pain after dental surgery. Intern Emerg Med 2008; 3:123-6. [PMID: 18437292 DOI: 10.1007/s11739-008-0143-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 02/28/2008] [Indexed: 12/01/2022]
Affiliation(s)
- Enzo Porteri
- Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Brescia, Italy
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28
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Roccia F, Diaspro A, Pecorari GC, Bosco G. Pneumomediastinum and cervical emphysema associated with mandibular fracture. THE JOURNAL OF TRAUMA 2007; 63:924-6. [PMID: 17308496 DOI: 10.1097/01.ta.0000222553.43557.ea] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Fabio Roccia
- Divisions of Maxillofacial Surgery, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
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29
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Uehara M, Okumura T, Asahina I. Subcutaneous cervical emphysema induced by a dental air syringe: a case report. Int Dent J 2007; 57:286-8. [PMID: 17849689 DOI: 10.1111/j.1875-595x.2007.tb00134.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Subcutaneous emphysema is one potential complication of dental procedures, although most cases of emphysema implicate operative procedure. We present a rare case of subcutaneous emphysema which arose due to using an air syringe to dry the gingiva in the lower jaw.
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Affiliation(s)
- Masataka Uehara
- Division of Regenerative Oral Surgery, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Japan.
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30
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Coldron J. Management of a Respiratory Emergency in the Antarctic Winter: A Case of Foreign Body Aspiration. Wilderness Environ Med 2007; 18:120-6. [PMID: 17590062 DOI: 10.1580/06-weme-cr-017r2.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
I report on a case of left main bronchus occlusion by an inhaled foreign body at a remote Antarctic scientific base during the austral winter. The dilemmas of on-site treatment and the challenges of aeromedical evacuation from such a remote environment are presented.
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Affiliation(s)
- Joanna Coldron
- British Antarctic Survey Medical Unit, Sheffield, United Kingdom.
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Bars N, Atlay Y, Tülay E, Tanju G. Extensive subcutaneous emphysema and pneumomediastinum associated with blowout fracture of the medial orbital wall. ACTA ACUST UNITED AC 2007; 64:1366-9. [PMID: 17514044 DOI: 10.1097/01.ta.0000235507.60878.3d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Naiboğlu Bars
- Department of Otolaryngology-Head and Neck Surgery, Haydarpaoa Numune Training and Research Hospital, Istanbul, Turkey.
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32
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Iqbal M, Ikram M, Raza F, Banday N. Surgical Emphysema in the Neck as a Result of a Dental Procedure. EAR, NOSE & THROAT JOURNAL 2005. [DOI: 10.1177/014556130508401115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the development of subcutaneous emphysema in a middle-aged woman that occurred several hours after she had undergone a dental restoration procedure. The patient presented to the emergency department, and she was admitted for observation and prophylactic antibiotic coverage. She recovered in 3 days without further intervention and was discharged.
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Affiliation(s)
- Moghira Iqbal
- Department of Otolaryngology–Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mubasher Ikram
- Department of Otolaryngology–Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Farhan Raza
- Department of Dentistry, Aga Khan University Hospital, Karachi, Pakistan
| | - Ninette Banday
- Department of Dentistry, Aga Khan University Hospital, Karachi, Pakistan
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Tosun F, Ozer C, Akcam T, Gerek M, Yetiser S. A Patient of Severe Cervicofacial Subcutaneous Emphysema Associated With Munchausen??s Syndrome. J Craniofac Surg 2005; 16:661-4. [PMID: 16077312 DOI: 10.1097/01.scs.0000168772.71356.2b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Subcutaneous cervicofacial emphysema is an entity with the presence of air within the fascial planes of the head and neck, which results from various causes. A case of severe subcutaneous cervicofacial emphysema associated with Munchausen's syndrome is presented. Detailed diagnostic investigations to find out the organic cause of the condition were failed. Episodes of facial swelling were prevented by psychiatric support. Munchausen's syndrome should be kept in mind among the etiological factors of subcutaneous cervicofacial emphysema cases, in whom no organic causes can be found out.
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Affiliation(s)
- Fuat Tosun
- Department of ORL and HNS, Gulhane Medical School, Etlik 06018, Ankara, Turkey.
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Roccia F, Griffa A, Nasi A, Baragiotta N. Severe subcutaneous emphysema and pneumomediastinum associated with minor maxillofacial trauma. J Craniofac Surg 2004; 14:880-3. [PMID: 14600631 DOI: 10.1097/00001665-200311000-00011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In the maxillofacial region, subcutaneous emphysema, which occurs after fractures of the pneumatic paranasal sinuses, is a common finding in a maxillofacial surgeon's daily practice. Pneumomediastinum secondary to these fractures is a less frequent event, however, without thoracic or abdominal injuries. The authors report a case of severe subcutaneous emphysema and pneumomediastinum that occurred after fractures of the nasal bones and medial orbital wall. The etiology, diagnosis, and treatment modalities of mediastinal emphysema are discussed.
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Affiliation(s)
- Fabio Roccia
- Division of Maxillofacial Surgery, S. Giovanni Battista Hospital, University of Torino, Torino, Italy.
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Oliver R, Coulthard P. POST-OPERATIVE SURGICAL EMPHYSEMA FOLLOWING THE USE OF A PEAK FLOW METER. Br J Oral Maxillofac Surg 2002. [DOI: 10.1016/s0266-4356(02)00136-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Abadal JM, Álvarez MJ, Torre JDL, Guerra AB. Enfisema subcutáneo y neumomediastinosecundarios a extracción dental. RADIOLOGIA 2002. [DOI: 10.1016/s0033-8338(02)77045-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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