Pneumomediastinum after dental surgery

Causes of subcutaneous emphysema following dental procedures: a systematic review of cases 1993-2020

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.

Complication of tracheotomy: A case of fatal pneumomediastinum in spontaneous ventilation

Pneumomediastinum is defined as the presence of free air in the mediastinal space. It is classically defined as either spontaneous or secondary pneumomediastinum, depending on whether a cause can be recognised (e.g. trauma, intrathoracic infections or medical procedures such as dental or facial surgery and tracheotomy). It can be associated with pneumothorax and subcutaneous emphysema of the cervico-facial area because of the ascent of the air from the mediastinum towards the neck. To our knowledge, only one case of death from pneumomediastinum due to tracheotomy has previously been recorded. We report a case of death due to pneumomediastinum, which occurred in a patient with a tracheotomy during spontaneous ventilation. The 65-year-old man underwent surgical mandibular reconstruction with a custom-made titanium plate for osteonecrosis with temporary tracheotomy. The patient received mechanical ventilation only during surgery. On day 3, when the tracheotomy was closed, the patient experienced a rapid deterioration of lung ventilation with initial development of subcutaneous cervical emphysema. Although a tracheotomy tube was promptly inserted, the patient developed massive subcutaneous cervico-facial emphysema with a drop in oxygen capillary saturation. The man died after half an hour of resuscitation due to a massive pneumomediastinum. In this paper, we discuss the epidemiology, aetiology, physiopathology, complications and necropsy findings in pneumomediastinum, focusing on the aspects of our case compared to the only other case reported.

Massive subcutaneous emphysema developing before surgery for mandibular fracture: a case report

Preoperative massive subcutaneous emphysema before intubation is extremely rare. However, this complication may be potentially lethal, depend on the condition of air spreading. Subcutaneous emphysema which occurs intra- or postoperative period is sometimes iatrogenic because the air is introduced into the tissue space through the hole injured by the operation. But the emphysema in this case occurred preoperatively by the pressure of the bag valve mask, because the patient had an intra-oral wound, which reaches the submental space. In this report, we describe an extremely rare case of preoperative massive emphysema of the patient with the mandibular fracture.

Iatrogenic pneumomediastinum with extensive subcutaneous emphysema after endodontic treatment: report of 2 cases

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.

Subcutaneous cervical emphysema induced by a dental air syringe: a case report

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.

Subcutaneous emphysema and pneumomediastinum secondary to dental extraction: a case report and literature review

Here, we present the case of a woman who suffered from acute dyspnea and right cheek and neck swelling during molar extraction. The use of a high-speed dental drill may introduce air into the soft tissue and lead to subcutaneous emphysema and pneumomediastinum. After a review of the literature, we found that subcutaneous emphysema and pneumomediastinum are rare complications secondary to dental extraction. We report this case because physicians in the emergency department may misdiagnose the symptoms as an allergic reaction. Dentists should be more aware of air leak during dental extraction.

Pneumomediastinum and subcutaneous emphysema as the manifestation of emphysematous pyelonephritis

Pneumomediastinum, a collection of mediastinal air, often results from the rupture of intrathoracic structures. A 41-year-old diabetic woman initially presented with signs of pneumomediastinum and nuchal subcutaneous emphysema, but was finally diagnosed with unilateral emphysematous pyelonephritis. Pneumomediastinum as a presentation in retroperitoneal infection has not been reported previously, which prompts us to discuss its etiology and emphasize the importance of physical examination.