Subcutaneous facial emphysema secondary to a dental procedure

Subcutaneous emphysema is a possible but infrequent consequence of dental procedures. We present the case of a 6-year-old healthy boy transferred from a dental clinic immediately after local anaesthesia for tooth extraction, due to sudden orbital and facial swelling. On physical examination, oedema of the left upper eyelid with fine crepitus on palpation and left hemiface oedema with local pain were observed. Ophthalmologic observation was normal. CT scan of the face and orbits documented extensive infiltration of the subcutaneous tissue planes of the left face by air, with extension to the external part of the body of the mandible, retromaxillary fat, masticatory muscle spaces, parapharyngeal space and adjacent to the orbital roof. After completing initial evaluation, the dentist confirmed the use of an air-driven device during local anaesthesia administration. The patient improved with conservative treatment. Early recognition of this condition is essential to provide an adequate clinical assessment with exclusion of possible life-threatening complications.