Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report

Department of Oral Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (Impact Factor: 1.46). 03/2009; 107(4):e33-8. DOI: 10.1016/j.tripleo.2008.12.019
Source: PubMed

ABSTRACT Most cases of pneumomediastinum are caused by iatrogenic injury during surgery on the cervical region and chest or by tracheostomy. It is also well known that emphysema may occur secondary to dental treatment using an air turbine drill, but there have been few cases of emphysema extending to involve the mediastinum. Presented is a rare case in which subcutaneous emphysema and pneumomediastinum developed asymptomatically, probably due to extraction of a mandibular third molar, and were found incidentally on the day after the dental procedure. To avoid subcutaneous emphysema and pneumomediastinum associated with dental treatment and surgical intraoral procedures such as tooth extraction, air turbine drills should be used only when it is essential.

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    ABSTRACT: Subcutaneous emphysema, is a rare occurrence in dental practice. It is usually benign and self-limiting; never-theless, severe consequences can result from surgical treatment. Emphysema occurs when air is injected into the subcutaneous layer of the tissue, this may come from either an air turbine handpiece or air syringe. Due to the danger of developing emphysema, procedures using compressed air are not recommended in dental extractions involving the raising of a skin flap, bone sectioning or exeresis. Two determining factors are always involved with subcutaneous emphysema. On the one hand, a compressed air procedure (air turbine handpiece, air-water syringe), and on the other, a communication between the oral cavity and deeper tissue producing dissection. Early diagnosis and treatment are critical to prevent the trapped air leaking into other areas. The aim is to present a case of subcutaneous emphysema related to dental extraction, without raising a mucoperios-teal flap, possibly caused by close contact between the air turbine handpiece and the tooth during sectioning which forced air into the subcutaneous tissue. emphysema resulting from surgical extraction without elevation of a mucoperiosteal skin flap. J Clin Exp Dent. 2011;3(3):e265-7. e266 J Clin Exp Dent. 2011;3(3):e265-7. Subcutaneous emphysema.
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