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Peters M, Shall F, Evrard L. Pneumomediastinum after Third Molar Extraction: Case Report, Physiopathology, and Literature Review. Case Rep Dent 2023; 2023:4562710. [PMID: 37575892 PMCID: PMC10415080 DOI: 10.1155/2023/4562710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 08/15/2023] Open
Abstract
Wisdom tooth extraction is a common procedure in dentistry and stomatology. Subcutaneous emphysema is a rare postoperative complication and commonly remains localized. However, it may spread to the mediastinum, endangering the life of the patient. This present paper presents a case study of pneumomediastinum after wisdom tooth extraction without the use of a compressed air turbine and reviews the cases of subcutaneous emphysema after third molar extraction published in the literature since 2010. The aim of this work is to inform preventive measures, pathophysiological processes, and management related to this complication.
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Affiliation(s)
| | - Firas Shall
- Erasmus Hospital, Lennik Road, 900 Brussels, Belgium
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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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Patel MIA, Barabas A. "Fish Gill" Incisions for Severe Periorbital Surgical Emphysema Following Tension Pneumothorax - A Case Report and Review of the Literature. JPRAS Open 2021; 30:128-132. [PMID: 34557580 PMCID: PMC8445807 DOI: 10.1016/j.jpra.2021.08.002] [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: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background Surgical emphysema refers to the presence of air within the subcutaneous space and is a known complication of chest drain insertion. Symptoms range from mild crepitus of the chest wall to the accumulation of air in the face and neck, which can ultimately result in cardiovascular compromise. Objective The aim of this article is to present a rare case of cervical, facial and periorbital surgical emphysema following chest drain insertion, and describes a novel use of ‘fish gill’ incisions in the palpebromalar groove with an associated review of the literature. Case Report A 68-year-old gentleman presented with acute dyspnoea due to a right-sided tension pneumothorax. Emergency decompression with a Seldinger chest drain resulted in persistent cervical, facial and periorbital surgical emphysema causing difficulty in movement, inability to open the eyes and progressive risk to cervical venous return. “Fish gill’ incisions at the lateral-most edge of the palpebromalar groove, down to the level of the orbicularis oculi muscle, rapidly released air from the face and neck, alleviating discomfort, reducing venous compression and restoring vision. Conclusion Cervical, fascial and periorbital surgical emphysema may be resolved with the use of “fish gill” incisions at the lateral palpebromalar groove and simple drains. To the best of our knowledge, this method has not been reported previously in the literature.
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Affiliation(s)
- Manal Irshad Ahmed Patel
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, UK
| | - Anthony Barabas
- Department of Plastic Surgery, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK
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Lo C, Kim AHS, Hieawy A, Nathoo NA. Acute Vision Loss as an Ophthalmic Complication of Dental Procedures. Semin Ophthalmol 2021; 36:75-81. [PMID: 33641577 DOI: 10.1080/08820538.2021.1890788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Acute vision loss has been previously described as a complication of dental procedures through a variety of mechanisms. The vision loss is typically transient, although permanent loss has been reported. Physicians, including ophthalmologists, typically lack formal education around dental procedures and may be uninformed about the risks to ocular or periocular structures as well as the types of complications that can arise. We aimed to summarize literature describing the various mechanisms by which dental procedures can lead to vision loss in order to equip physicians (primary care, emergency medicine, and ophthalmologists) with a better understanding of the mechanisms by which dental procedures can lead to acute vision loss. Methods: A literature search (1950 to 2020) identified articles discussing acute vision loss as a complication of dental procedures. Results: Dental procedures can result in a variety of ophthalmological conditions through ischemic, infectious, compressive, and anesthetic-related etiologies. Conclusions: While the majority of vision loss is transient and requires little management, there are vision and life-threatening complications that can arise and would require assessment and appropriate treatment.
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Affiliation(s)
- Cody Lo
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ashley H S Kim
- Department of Oral Biological and Medical Science, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Ahmed Hieawy
- Department of Oral Biological and Medical Science, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Nawaaz A Nathoo
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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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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Orbital Emphysema: A Case Report and Comprehensive Review of the Literature. Ophthalmic Plast Reconstr Surg 2019; 35:1-6. [PMID: 30130334 DOI: 10.1097/iop.0000000000001216] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to report a case of persistent and likely self-induced orbital emphysema (OE) following functional endoscopic sinus surgery with dislodgement of a previously placed orbital floor implant and to review the literature surrounding etiologies, pathophysiology, and management of OE. METHODS Case report and review of the literature. RESULTS AND DISCUSSION While blunt trauma resulting in disruption of the medial orbital wall is the most common cause of OE, there are an additional 25 underlying etiologies reported in the current literature. Pathophysiology of OE is somewhat dependent on underlying etiology but often involves a 1-way ball valve mechanism such that air may enter the orbit but not exit. When sufficient air enters the orbit, complications secondary to increased intraorbital pressure, including central retinal artery occlusion and compressive optic neuropathy, can occur. Mild cases of OE are typically observed, with most resolving within 7 to 10 days. Moderate cases are often managed by lateral canthotomy and cantholysis with possible needle decompression. Severe cases may require urgent surgical decompression. While the majority of cases of OE are benign and self-limited, there have been 4 reports in the literature documenting significant vision loss. CONCLUSIONS Although there is often a history of trauma in patients presenting with OE, many other underlying etiologies have been reported with several cases occurring spontaneously. As such, OE should be included on the differential for a patient presenting with a sudden onset of orbital signs.
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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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Bhat V, Hadne N, Tobias R. Air Leak into the Soft Tissues During the Puffed Cheek CT Evaluation of Oral Cavity: Diagnosis and Implication of a Rare Phenomenon. J Maxillofac Oral Surg 2017; 16:374-376. [PMID: 28717297 DOI: 10.1007/s12663-016-0952-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022] Open
Abstract
Leakage of small pockets of air in to soft tissues of cheek along vascular bundle is reported in a patient with ulcerated oral malignancy with history of recent biopsy. Leakage occurred during an attempt to puff the cheek during CT examination of oral cavity. Hereto undocumented phenomenon was self limiting and did not lead to clinical disability. Imaging appearance and likely mechanism of the complication are discussed.
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Affiliation(s)
- Venkatraman Bhat
- Department of Radiology, Narayana Health, Mazumdar Shaw Medical Center, 309, Greenwoods Apt, Bommasandra, Bangalore, 560099 India
| | - Naveen Hadne
- Head and Neck Surgery, Narayana Health, Mazumdar Shaw Medical Center, Bangalore, India
| | - Richard Tobias
- Department of Radiology, Narayana Health, Mazumdar Shaw Medical Center, 309, Greenwoods Apt, Bommasandra, Bangalore, 560099 India
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Rodríguez-Calzadilla M, García-Vázquez M, Contreras-Espuny M, Soto-Guerrero A, Rodríguez-Suárez AH, Benítez-del-Castillo-Sánchez FJ, García-Íñiguez M. Enfisema periorbitario secundario a procedimiento dental: reporte de un caso y revisión de la literatura. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Asnani HT, Mehta VC, Nair AG, Jain V. Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation. Indian J Ophthalmol 2016; 63:541-2. [PMID: 26265649 PMCID: PMC4550992 DOI: 10.4103/0301-4738.162615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self-resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation.
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Farina R, Zaetta A, Minenna L, Trombelli L. Orbital and Periorbital Emphysema Following Maxillary Sinus Floor Elevation: A Case Report and Literature Review. J Oral Maxillofac Surg 2016; 74:2192.e1-2192.e7. [PMID: 27474464 DOI: 10.1016/j.joms.2016.06.186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 11/15/2022]
Abstract
During the past 150 years, subcutaneous emphysema has been described as a rare complication in dentistry, the etiology of which might be maneuvers performed by the patient (eg, sneezing while the mouth is closed, blowing the nose) or the dental professional through the use of specific dental instruments (eg, dental drill, air syringe, etc). Irrespective of etiology, air is forced through the soft tissues, thus producing rapid swelling of the area. According to the most recent literature reviews, the iatrogenic etiology is the most frequent. This report describes the first case of emphysema related to the orbital and periorbital region after a maxillary sinus floor elevation procedure.
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Affiliation(s)
- Roberto Farina
- Full-Time Researcher, Research Center for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara; Full-Time Researcher, Operative Unit of Dentistry, University Hospital of Ferrara, Ferrara; Chair, Department of Oral Surgery, School of Dentistry, University of Ferrara, Ferrara, Italy.
| | - Antonio Zaetta
- Clinical Fellow, Research Center for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Luigi Minenna
- Part-Time Faculty, School of Dentistry, University of Ferrara, Ferrara, Italy
| | - Leonardo Trombelli
- Director, Research Center for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara; Director, Operative Unit of Dentistry, University Hospital of Ferrara, Ferrara; Chair, Department of Periodontology, School of Dentistry, University of Ferrara, Ferrara, Italy
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