Pneumomediastinum and Subcutaneous Emphysema after Periodontal Treatment Using Air-Flow Equipment : A Case Report

Case report: Subcutaneous emphysema is a rare but serious side effect of dental and oral surgery procedures. It is characterized by air being forced underneath the tissue, leading to swelling, crepitus on palpation, and with potential to spread along the fascial planes to the periorbital, mediastinal, pericardial, and/or thoracic spaces. A wide range of causes has been documented for the origin of subcutaneous emphysema during dental treatment including: crown preparations, endodontic therapy, extractions, as well as oral surgery procedures. The patient was a 58-year-old woman who presented to the Seoul St. Mary’s hospital emergency department with a chief complaint of facial edema, dyspnea and chest discomfort after periodontal treatment using an air-flow equipment in local dental clinic. Oxygen therapy and intravenous injection of steroid and antihistamine were done. It was noted that the patient had pain and swelling on left lower molar region, pus discharging on same site. Severe edema was observed on periorbital region to neck with heatness. An audible crepitus sound was heard during palpation. Antibiotic therapy was done, as symptom suggesting dental abscess is observed. After injection of antibiotics, symptom was relieved, but she felt chest discomfort continuously. CT scan with contrast depicted confluent and extensive soft tissue emphysematous changes involving face and deep neck spaces and pneumomediastinum. The patient was referred to thoracic surgery department, oxygen therapy was decided continuously. After 10 h, patient’s chief complaint was resolved. After 1 week, all symptoms disappeared and follow-up neck CT scan finding was disappearance of edema and pneumomediastinum.