Cardiothoracic Surgery: Student/Resident Case Report Poster - Cardiac and Thoracic Surgery |

Severe Subcutaneous Emphysema and Pneumomediastinum After a Molar Extraction: A Rare Case in Mexico FREE TO VIEW

Diana Yepez-Ramos, MD; Walid Dajer-Fadel, MD; Serafín Ramírez-Castañeda, MD; Octavio Flores-Calderón, MD; Carlos Latorre-Dávila, MD; Rubén Argüero-Sánchez, MD
Author and Funding Information

General Hospital of Mexico Dr. Eduardo Liceaga, Mexico City, Mexico

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):61A. doi:10.1016/j.chest.2016.08.068
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SESSION TITLE: Student/Resident Case Report Poster - Cardiac and Thoracic Surgery

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Cervical emphysema with pneumomediastinum can be defined as the presence of subcutaneous air within the neck soft tissue and mediastinum. This clinical condition is reported to be caused by a high-speed air-turbine dental drill or other pressurized appliances used during dental procedures. Especially the ones involving the molar teeth; air can diffuse into the pterygomandibular region and lateral parapharyngeal spaces from the retromolar region extending into the mediastinum. 1, 2

CASE PRESENTATION: A 23 year-old female presented to the Emergency Department with subcutaneous emphysema, she denied dyspnea, fever or thoracic pain. Three days before arrival she had been performed a lower left molar surgical extraction with local anesthesia. During physical examination, cervical subcutaneous emphysema was palpable, with normal vital signs. Chest CT revealed peri-tracheal and esophageal free air with no evidence of pneumothorax or any active infectious gas-producing process. Treated with supplemental oxygen and discharged the next day without complications.

DISCUSSION: Pneumomediastinum is a condition characterized by the presence of gas within the mediastinum. It can develop iatrogenically due to head and neck surgery, intubation, mechanical ventilation, esophageal perforation, and dental surgery.1 Subcutaneous emphysema is produced by the entrance of air into the facial planes and neck through the area of the wisdom tooth during extraction. The dental drill introduces pressurized air at up to 16mmHg. Through this mechanism, air enters through the molar roots into the retropharyngeal space, which is connected to the mediastinum. Treatment is usually conservative. Supplemental O2 at 100% is the treatment of choice with a self-limiting course without the need for additional therapies. 3

CONCLUSIONS: We conclude that the development of subcutaneous emphysema and pneumomediastinum during wisdom tooth extraction is a very uncommon complication, but it is necessary to know how to diagnose and make appropriate treatment decisions.

Reference #1: Ikuko Arai, Takayuki Aoki, Hiroshi Yamazaki, Yoshihide Ota, Akihiro Kaneko, Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report; Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 April; Volume 107, Issue 4, Pages e33-e38

Reference #2: Isa Döngel, Mehmet Bayram, Ismail Önder Uysal, Güven Sadi Sunam; Subcutaneous emphysema and pneumomediastinum complicating a dental procedure; Ulus Travma Acil Cerrahi Derg 2012;18(4):361-363

Reference #3: Pilar Guillén-Paredes, Vania Novoa-Juiz, Luis Carrasco-González; Asymptomatic Pneumomediastinum After Wisdom Tooth Extraction Arch Bronconeumol. 2012;48:217-8

DISCLOSURE: The following authors have nothing to disclose: Diana Yepez-Ramos, Walid Dajer-Fadel, Serafín Ramírez-Castañeda, Octavio Flores-Calderón, Carlos Latorre-Dávila, Rubén Argüero-Sánchez

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