Pneumomediastinum After Third Molar Surgery: A Case Report

Cervicofacial emphysema is defined as the pathological presence of air within the fascial spaces of the neck and face. Dental procedures are a recognized but uncommon cause, and only rarely do they involve the mediastinum; such cases are typically related to the use of high-speed air-driven handpieces or air/water (triple) syringes, producing pneumomediastinum. We report a 22-year-old woman who presented to the emergency department with sudden-onset dyspnea immediately after the extraction of two right-sided third molars performed with high-speed air-driven rotary instruments. Contrast-enhanced computed tomography confirmed cervical subcutaneous emphysema and pneumomediastinum. She was admitted for airway and hemodynamic monitoring; an esophagogram excluded esophageal injury, prophylactic antibiotics were administered, and she recovered uneventfully, being discharged on the third day. At one-week follow-up, the patient reported complete resolution of dyspnea and chest pain, with no residual cervical swelling or crepitus. Although air-driven handpieces and air syringes are safe and essential tools in dental practice, their use during invasive procedures and in anatomically high-risk areas warrants caution, as it may rarely result in this potentially life-threatening complication. Early recognition and a conservative, multidisciplinary approach are key to a favorable outcome.