Iatrogenic subcutaneous emphysema of dental and surgical origin: a literature review.
OBJECTIVE
Subcutaneous emphysema arises when air is forced beneath the tissue, leading to swelling, crepitus on palpation, and potential to spread along the fascial planes. The goal of this literature review is to alert the oral and maxillofacial surgeon to the inciting factors, diagnosis, and management of subcutaneous emphysema.


METHODS
A comprehensive search of the medical and dental literature from 1993 to 2008 was performed using PubMed, and yielded 32 case reports of subcutaneous emphysema. Only cases associated with dental or surgical procedures were included. Cases of trauma were excluded.


RESULTS
Sixteen of the 32 cases were linked to the use of air-driven handpieces. Other cases involved a CO(2) laser, a NO(2) cryomachine, an air abrasive system, endotracheal intubation/ventilation, and patient activities after surgical procedures. Of the cases reviewed, 5 resulted in significant complications after subcutaneous emphysema.


CONCLUSIONS
Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening effects. Care should be taken when using air-driven handpieces or performing endotracheal intubation/ventilation. Additionally, instructions should be given to patients after procedures violating the epithelium to reduce the incidence of subcutaneous emphysema. When subcutaneous emphysema does arise, it must be quickly diagnosed and properly managed to reduce further complications.
McKenzie
Wm Stuart
WS
Tufts University School of Dental Medicine, Boston, MA, USA.
Rosenberg
Morton
M
D003762:Dental Instruments / Q000009:adverse effects; D003814:Dentistry, Operative; D006801:Humans; D007049:Iatrogenic Disease; D007442:Intubation, Intratracheal / Q000009:adverse effects; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D013352:Subcutaneous Emphysema / Q000209:etiology*