Iatrogenic subcutaneous emphysema after dental treatment

February 12, 2014
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Abstract

Subcutaneous emphysema as a complication of a dental procedure is uncommon. When it does occur, it can result in significant and sometimes alarming cervicofacial swelling. Management in most cases involves close observation while awaiting spontaneous resolution. However, in some cases the swelling can progress to cause serious complications and even death. Even though such complications are more commonly seen by our dental and oromaxillofacial surgery colleagues, otolaryngologists should be aware of this condition since we are often asked to consult in these cases. We describe the case of a 13-year-old girl who presented to the emergency department of our institution with an unusually dramatic acute-onset cervicofacial swelling after she had undergone a dental procedure earlier in the day. Computed tomography revealed subcutaneous emphysema. The patient was admitted to the hospital for close observation, and within 24 hours her condition had improved significantly. Shortly after discharge, she experienced a complete recovery. We review the clinical presentation, physical examination findings, diagnostic workup, and management of this complication.

Introduction

Subcutaneous emphysema occurs as a result of an abnormal presence of or introduction of air or gas into tissue or tissue spaces. It occurs in various scenarios, including during dental treatment. Dental procedures that involve the use of air-powered tools and high-speed, water-cooled equipment have been implicated as the inciting event for this complication.1 Expeditious diagnosis and management of subcutaneous emphysema are important to facilitate recovery.

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