Cervicofacial and mediastinal emphysema after dental extraction

Subcutaneous emphysema (SE) is a rare but potentially life-threatening complication in dental procedures. The development of SE and pneumomediastinum (P) during tooth extraction is an uncommon complication. The roots of the second and third lower molars (and, rarely, of the premolar and first molar) communicate directly with the sublingual and submandibular spaces. Occasionally, after a dental operation, the pressurized air from the drill is forcefully injected into the surrounding subcutaneous tissues proximal to the extraction site in the facial planes. The air might pass through the sublingual and submandibular spaces to the pterygomandibular, parapharyngeal and retropharyngeal spaces, and to the mediastinum. Molar extraction is a common procedure in dental surgery. We report a rare case of extensive cervicofacial SE as well as P, following mandibular second molar extraction with the use of a high-speed dental handpiece, which is specifically designed for restorative treatment. Careful observations of the symptoms and clinical course, and an early initiation of pharmacologic therapy are recommended.