J Korean Assoc Oral Maxillofac Surg.  2017 Feb;43(1):49-52. 10.5125/jkaoms.2017.43.1.49.

Iatrogenic subcutaneous cervicofacial emphysema with pneumomediastinum after class V restoration

  • 1Department of Dentistry, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. sangwoone@hanmail.net
  • 2Department of Prosthodontics and Research Institute of Oral Science, Gangneung-Wonju National University, Gangneung, Korea.


Subcutaneous facial emphysema after dental treatment is an uncommon complication caused by the invasion of high-pressure air; in severe cases, it can spread to the neck, mediastinum, and thorax, resulting in cervical emphysema, pneumomediastinum, and pneumothorax. The present case showed subcutaneous cervicofacial emphysema with pneumomediastinum after class V restoration. The patient was fully recovered after eight days of conservative treatment. The cause of this case was the penetration of high-pressure air through the gingival sulcus, which had a weakened gingival attachment. This case indicated that dentists should be careful to prevent subcutaneous emphysema during common dental treatments using a high-speed hand piece and gingival retraction cord.


Subcutaneous emphysema; Mediastinal emphysema

MeSH Terms

Mediastinal Emphysema*
Subcutaneous Emphysema


  • Fig. 1 Anterior-posterior chest radiograph revealed pneumomediastinum (arrows) and subcutaneous emphysema (arrowheads) with streaky radiolucencies.

  • Fig. 2 Diffuse soft tissue emphysema in the masticator space, peripharyngeal space, and superior mediastinum was observed on computed tomography. A. Coronal view at the mental foramen level: the facial emphysema extended into the right orbital cavity. B. Coronal view at the pharyngeal and laryngeal regions: the cervical emphysema was observed in the peripharyngeal space and superior mediastinum.

  • Fig. 3 Diffuse soft tissue emphysema in the peripharyngeal space, both the anterior and posterior triangles of the neck, the anterior chest wall, and the superior mediastinum was observed on computed tomography. A. Axial view at the thyroid gland and clavicle: the cervical emphysema was observed in the peripharyngeal space, both the anterior and posterior triangles of the neck, and the anterior chest wall. B. Axial view at the aortic arch: the emphysema was observed on the anterior chest wall and the superior mediastinum.


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