Cervicofacial and mediastinal emphysema after dental extraction

Area of Science:

• Oral and Maxillofacial Surgery
• Dental Anesthesiology

Background:

• Subcutaneous emphysema (SE) and pneumomediastinum (P) are rare but serious complications in dental procedures.
• Molar extraction, particularly of mandibular molars, is a common dental surgery.

Observation:

• The study reports a rare case of extensive cervicofacial SE and P following mandibular second molar extraction.
• A high-speed dental handpiece, typically used for restorative treatments, was employed during the extraction.
• Anatomical proximity of molar roots to fascial planes facilitates air migration.

Findings:

• Pressurized air injected during dental procedures can travel through fascial planes, including sublingual and submandibular spaces.
• Air can extend to pterygomandibular, parapharyngeal, retropharyngeal spaces, and ultimately the mediastinum.
• Mandibular second molar extraction using a high-speed handpiece can lead to extensive SE and P.

Implications:

• Early recognition of SE and P symptoms post-extraction is crucial for timely management.
• Pharmacologic therapy initiation should be prompt to manage these rare complications.
• This case underscores the importance of considering potential air embolism during specific dental procedures.