Severe breathing and swallowing difficulties during routine restorative dentistry

Area of Science:

• Oral and Maxillofacial Surgery
• Emergency Medicine
• Radiology

Background:

• Subcutaneous emphysema is a rare complication following dental procedures, particularly those involving air-driven instruments.
• It can be misdiagnosed as an allergic or anaphylactic reaction due to similar presenting symptoms like facial swelling and breathing difficulties.
• Key terms include dental care, pneumomediastinum, and restorative dentistry.

Observation:

• A 57-year-old woman developed breathing and swallowing difficulties, along with facial and neck swelling, after restorative dental treatment.
• Clinical examination revealed palpable crepitus in the head, neck, and pre-sternal region.
• Imaging confirmed extensive air in the deep facial planes, neck, and mediastinum.

Findings:

• The patient's symptoms were caused by subcutaneous emphysema secondary to restorative dental work, not an allergic reaction.
• Computed tomography scans were crucial in diagnosing the extent of the air dissection.
• The patient recovered fully with conservative management, including antibiotics and respiratory monitoring.

Implications:

• Accurate diagnosis of subcutaneous emphysema is vital to prevent unnecessary allergic reaction treatments.
• Awareness among dental and emergency professionals about this complication is crucial for timely and appropriate patient care.
• This case underscores the need for careful evaluation of symptoms following dental procedures, especially when air-driven equipment is used.