Extensive Cervicofacial and Mediastinal Emphysema Following Subgingival Air-Polishing for Peri-Implantitis: A Case...

Subcutaneous emphysema is an uncommon but potentially serious iatrogenic complication of dental treatment caused by the inadvertent introduction of pressurized air into soft tissues. Although air-polishing devices are widely used for biofilm disruption in peri-implant therapy, emphysema associated with subgingival air-polishing is rare.

We report a case of extensive cervicofacial and mediastinal emphysema following non-surgical peri-implantitis debridement at implant site 11 using a subgingival air-polishing device (PERIOFLOW, EMS, Nyon, Switzerland) with erythritol powder. The peri-implant site had an approximately 6-mm pocket and a labial sinus tract prior to treatment.

A 32-year-old man developed acute facial and cervical swelling shortly after the second cycle of debridement and rapidly extended to the contralateral face and bilateral neck. Imaging demonstrated air within the peri-implant region, with extensive spread to the bilateral periorbital, facial, parapharyngeal, retropharyngeal, submandibular, cervical, and upper mediastinal regions. The patient remained hemodynamically stable without airway compromise. He was admitted for monitoring and managed with oxygen therapy and intravenous antibiotics. Clinical swelling and crepitus improved substantially within 3 days, and he was discharged without further complications.

Extensive cervicofacial and mediastinal emphysema may occur during subgingival air-polishing for peri-implantitis, even after brief application. Early recognition, imaging, and appropriate monitoring are essential.