Cervicofacial emphysema following dental procedures

Cervicofacial emphysema is an infrequently reported sequela to dental surgery. Most cases result from the accidental introduction of air into the soft tissues during the use of air-driven, high-speed handpieces or air/water syringes. Surgical procedures, in particular removal of lower third molars, predispose to the development of an emphysema. The clinical presentation is usually a facial or cervicofacial swelling coincident with the dental treatment. The use of air instruments, immediate onset, crepitus and often a radiographically discernible enlarged facial space are the diagnostic features. Pain is not usually a feature. The possibility of mediastinal involvement should be recognized and the patient monitored appropriately. Active treatment requirements are minimal. Reassurance of the patient, antibiotic prophylaxis and analgesics, if required, are generally sufficient. This paper reviews the above features and discusses means of prevention. Early recognition and appropriate management are emphasized.