J Korean Assoc Oral Maxillofac Surg.  2018 Oct;44(5):212-219. 10.5125/jkaoms.2018.44.5.212.

Subcutaneous emphysema related to dental procedures

• Jeong CH
• Yoon S
• Chung SW
• Kim JY
• Park KH
• Huh JK

• KMID: 2430581
• DOI: http://doi.org/10.5125/jkaoms.2018.44.5.212

Abstract

OBJECTIVES
The objective of this study was to analyze 11 cases of subcutaneous emphysema associated with dental procedures from a single hospital and discuss approaches for accurate diagnosis and treatment of the condition.
MATERIALS AND METHODS
The medical records of 11 patients who were treated for subcutaneous emphysema related to dental procedures between January 2009 and April 2017 were analyzed retrospectively. Patients with subcutaneous emphysema within the facial area or that spread to the neck and beyond, including the facial region, were assigned to two groups and compared in terms of age, sex, and durations of antibiotic use, hospitalization, and follow-up until improvement. The correlation between location of the origin tooth and range of emphysema spread was analyzed.
RESULTS
The average durations of antibiotic use during conservative treatment and follow-up until improvement were 8.55 days (standard deviation [SD], 4.46 days) and 1.82 weeks (SD, 1.19 weeks), respectively. There was no intergroup difference in duration of antibiotic use (P=0.329) or follow-up (P=0.931). Subcutaneous emphysema was more common after dental procedures involving the maxilla or posterior region than after those involving the mandible or anterior region. There was no significant difference in air distribution according to location of the air orifice (maxilla, mandible, or both; P=0.106).
CONCLUSION
Upon adequate conservative treatment accompanied by prophylactic antibiotic treatment considering the risk of infection, patients showed signs of improvement within a few days or weeks. There was no significant difference in treatment period between patients with subcutaneous emphysema localized to the facial region and those with subcutaneous emphysema spreading to the neck or beyond. These findings need to be confirmed by analysis of additional cases.

Keyword

Subcutaneous emphysema; Dental care; Mediastinal emphysema; Cervicofacial; Iatrogenic disease

MeSH Terms

Dental Care
Diagnosis
Emphysema
Follow-Up Studies
Hospitalization
Humans
Iatrogenic Disease
Mandible
Maxilla
Mediastinal Emphysema
Medical Records
Neck
Retrospective Studies
Subcutaneous Emphysema*
Tooth

Figure

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  Fig. 1 Serial radiographs of the neck in lateral view. A. Hospital day 1: Soft-tissue swelling and presence of air in subcutaneous tissues of the submandibular space, anterior neck, and retropharyngeal space (arrows). B. Hospital day 2: Air in the submandibular space and middle region of the neck had been partially absorbed (arrows), while air remaining above the scapula could still be observed (dotted arrow). C. Hospital day 3. D. Last visit (9 days after onset): Air in the mandibular and cervical regions had almost disappeared (arrows).

• 

  Fig. 2 Computed tomography images showing subcutaneous emphysema (hospital day 1). A. Axial view: Right buccal, parapharyngeal, and retropharyngeal space (arrows). B. Coronal view: Submandibular and buccal space (arrows). C. Sagittal view: Submandibular space and anterior neck region (arrows); deep neck space (dotted arrow). D. Axial view at the level of the heart: Air can be seen in the middle mediastinum (arrow).

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