Iatrogenic retropharyngeal emphysema with impending airway obstruction

The causes, diagnosis, sequelae, and treatment of interstitial emphysema of the face, neck, and thorax have been previously described in the medical and dental literature and are reviewed here. We present a unique case of a patient who, following dental amalgam restoration, developed severe retropharyngeal emphysema with impending airway obstruction, cervicofacial subcutaneous emphysema, and pneumomediastinum. Management consisted of urgent tracheotomy, broad-spectrum prophylactic antibiotic coverage, close observation, and reassurance. The likely mechanisms of precipitation and extension of the emphysema in this patient are discussed.