title: Diffuse subcutaneous emphysema, pneumomediastinum, and pneumothorax after dental extraction.
abstract: Subcutaneous emphysema, pneumomediastinum, and pneumothorax may result from surgical procedures and trauma and usually do not present a diagnostic dilemma. We present a case of subcutaneous emphysema, pneumomediastinum, pneumothorax, and pneumoretroperitoneum after a dental procedure with an air-and-water-cooled turbine burr drill. This allowed air and water under pressure to be driven into the field and track through the fascial planes. Although this is a common occurrence, these patients frequently go undiagnosed or misdiagnosed as allergic reactions to locally administered anesthetic agents. If a large amount of air is injected, it may track into not only the subcutaneous tissues but also the mediastinum, pleural space, and retroperitoneal space. Patients with significant amounts of air must be admitted, observed for airway compromise, and be provided IV antibiotics and hydration.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: D
authors.initials: D
authors.lastname: Shackelford
authors.forename: J A
authors.initials: JA
authors.lastname: Casani
mesh_terms: D000328:Adult; D003754:Dental High-Speed Equipment / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008478:Mediastinal Emphysema / Q000209:etiology*; D011030:Pneumothorax / Q000209:etiology*; D012188:Retropneumoperitoneum / Q000209:etiology; D013352:Subcutaneous Emphysema / Q000209:etiology*; D014081:Tooth Extraction / Q000295:instrumentation