Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report
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.
- SourceAvailable from: Milouš Derner[Show abstract] [Hide abstract]
ABSTRACT: A 41-year-old man with injury of right half of the thorax, fractures of the left crural bones and paralysis of the right upper limb was admitted to our hospital. A CT examination at admission revealed bilateral pulmonary contusion and bilateral fluid- and pneumothorax. In addition pneumomediastinum, pneumopericardium, subcutaneous emphysema and pneumorrhachis at the cervicothoracic transition was demonstrated. Abnormal findings in the skull and brain were not revealed. The fifth day after admission repeated CT examination demonstrated extensive frontal pneumocephalus on the right, presence of air in several cisterns and in the right optic nerve sheaths (pneumoopticus). Right frontal craniotomy was performed, dura mater was incised and air was evacuated. Rapid regression of pneomocephalus was evident postoperatively. The tenth day after admission MRI of the cervical spine and brachial plexus was performed. At the level of the C7 and C8, nerve roots pneumomenigocele and a nerve retracting ball indicating the presence of a nerve root injury were discernible. This case demonstrated that severe thoracic blunt trauma leads to acute increase of intrathoracic pressure with concomitant fluid- and pneumothorax, pneumomediastinum and pneumopericard. From the mediastinum air propagated subcutaneously. Disrupted cervical dural sheaths resulted in leakage of cerebrospinal fluid and entry of air from mediastinum to subdural and subarachnoid spinal and cranial space and to the subarachnoid space of the optic nerve.Prague medical report 01/2011; 112(1):56-66.
- [Show abstract] [Hide abstract]
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.01/2011; DOI:10.4317/jced.3.e265
- [Show abstract] [Hide abstract]
ABSTRACT: Various benign and malignant thoracic or abdominal diseases can cause subcutaneous emphysema on the chest, pneumomediastinum or pneumopericardium. To date only 7 cases have been reported on perforation of the sigmoid colon or the rectum presenting with these rare symptoms. We report a case of a 72-year-old woman who presented with thoracic and cervical subcutaneous emphysema, pneumomediastinum and pneumopericardium. Further examination revealed that this was caused by a rectal tumor causing large bowel obstruction and a consequent perforation of the transverse colon. Due to the patient's old age, poor health and the special anatomic situation after previous laparotomies, she presented with atypical symptoms. Subcutaneous emphysema of the chest, pneumomediastinum and pneumopericardium are uncommon symptoms and can be a real challenge in diagnosis. Especially in old patients with significant past medical history, life-threatening conditions present misleadingly with vague clinical symptoms. In case of these patients it is important to remember that even cardiopulmonary symptoms such as pneumomediastinum, pneumopericardium or subcutaneous emphysema of the chest can be signs of severe diseases in the abdomen.Magyar Sebészet (Hungarian Journal of Surgery) 10/2009; 62(5):308-11. DOI:10.1556/MaSeb.62.2009.5.4