title: Orbital, mediastinal, and cervicofacial subcutaneous emphysema after endodontic retreatment of a mandibular premolar: a case report.
abstract: BACKGROUND
  Subcutaneous emphysema (SCE) rarely occurs from endodontic treatment. Most reported cases of iatrogenic SCE occur in the cervicofacial region. Only a few cases have been reported of SCE extending into the mediastinum or orbital spaces. In the present report, we describe a concomitant occurrence of orbital, mediastinal, and cervicofacial SCE immediately after endodontic retreatment.
  
  
  METHODS
  A 33-year-old woman presented to the hospital with acute swelling of the right side of her face and neck. Earlier in the day, she began experiencing rapid swelling while undergoing endodontic retreatment of a mandibular right first premolar by her general dentist. The dentist immediately referred the case to an oral surgeon who then ordered additional tests and radiographic studies at the hospital. From there, the patient received consultation and comprehensive treatment by a multidisciplinary team of medical and dental staff.
  
  
  RESULTS
  Physical examination, laboratory tests, and computed tomographic studies confirmed a diagnosis of SCE. Extensive air pockets were detected within the orbital, mediastinum, and cervicofacial spaces. The patient was admitted to the hospital and underwent treatment and observation for massive SCE with likely secondary infection. On the fifth day, she was discharged after showing dramatic improvement.
  
  
  CONCLUSIONS
  SCE may go undetected or misdiagnosed. Complications may be fatal. Therefore, clinicians should apply preventive measures and know how to identify and manage SCE. We review reports of SCE in the last century, discuss etiology and differential diagnosis, and present recommendations for prevention and management of SCE.
authors.affiliation: Department of Dentistry, Lutheran Medical Center, Brooklyn, New York. Electronic address: gregan@post.harvard.edu.
authors.forename: Gregory K
authors.initials: GK
authors.lastname: An
authors.affiliation: Department of Dentistry, Lutheran Medical Center, Brooklyn, New York.
authors.forename: Boris
authors.initials: B
authors.lastname: Zats
authors.affiliation: Department of Dentistry, Lutheran Medical Center, Brooklyn, New York.
authors.forename: Marc
authors.initials: M
authors.lastname: Kunin
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005145:Face / Q000473:pathology*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008478:Mediastinal Emphysema / Q000209:etiology*; D009333:Neck / Q000473:pathology*; D009916:Orbital Diseases / Q000209:etiology*; D010348:Patient Care Team; D019233:Retreatment; D018915:Root Canal Preparation / Q000009:adverse effects; D012390:Root Canal Therapy / Q000009:adverse effects*; D013352:Subcutaneous Emphysema / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Dental iatrogenic disease; endodontic complications; mediastinal emphysema; pneumomediastinum; subcutaneous emphysema