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Subcutaneous emphysema as a complication of tooth extraction 	 Subcutaneous emphysema as a complication of tooth extraction
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Subcutaneous emphysema as a complication of tooth extraction Subcutaneous emphysema as a complication of tooth extraction

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  • 1. SUBCUTANEOUS EMPHYSEMA AS A COMPLICATION OF TOOTH EXTRACTION A.Vacic Health Center Pirot, General hospital, Department of pediatrics Correspodence to: [email_address]
  • 2. CAUSES OF SUBCUTANEOUS EMPHYSEMA (SCE)
    • PULMONARY
    • P neumot horax
    • P neumomediastinum
    • E X STRAPULMON ARY
    • Fractures of facial bones
    • Injuries of paranasal sinus
    • Dental procedures
  • 3. MEHANISMS OF APPEARING SCE ASSOCIATED WITH DENTAL PROCEDURES
    • Emphysema caused by cough
    • E m physema caused by direct introduction of air into tissue e.g. by air turbine or syringe
    • Emphysema caused by prolonged procedure
    • Unknown causes
  • 4. DIAGNOSIS
    • HISTORY:
    • Sudden swelling and feeling of pressure
    • CLINICAL SIGNS :
    • Swelling with crepitus
    • Absence of erythema, pain or palpatory tenderness
    • RENTGENOGRAPHY :
    • Radiolucent striations in soft tissue
  • 5. DIFFERENTIAL DIAGNOSIS
    • NECROTIIZING FASCIITIS
    • EXPANDING HEMATHOMA
    • ACUTE LYMPHADENITIS
    • ANGIONEUROTIC OEDEMA
  • 6. COMPLICATIONS
    • INFECTIONS
    • AIR EMBOLY
    • PNEUMOTHORAX ET PNEUMOMEDIASTINUM
  • 7. THERAPY
    • OXYGENATION
    • PROFILACTIC ADMINISTRATION OF ANTIBIOTICS
    • SURGERY (extreme cases)
  • 8.
    • CASE REPORT
    • History
    • A 17-year-old girl attended the hospital with facial swelling and chest discomfort that occurred during dental extraction. Half an hour earlier she was given a 2% Lidocain (with epinephrine) injection because of an extraction of right mandibular first molar. During the extraction, the crown of the tooth was broken so an air-turbine dental drill had to be used for dental root separation. During the resection, swelling on the right cheek, the right lower eyelid and the part of the neck suddenly occurred, and so did the feeling of pressure in neck and chest. Due to the suspicion of an allergic reaction, patient was administered an antihistaminic agent, together with a parenteral corticosteroid, and was sent to our institution where she was treated as an inpatient.
  • 9.
    • CASE REPORT
    • Physical examination
    • On admission, the patient was afebrilic, dispnoic, with respiratory rate 24, pulse rate 140, blood pressure 160/95mmHg, oxygen saturation 97%. She had the swellings of right eyelid, right cheek and neck (Fig 1 and 2) without local tenderness or erythematous change. The crepitus were palped in these areas. Lungs: normal breathing sound. Heart: regular rhythm, crunching sound with each hearth beat.
    • Laboratory findings
    • Laboratory findings were within normal ranges.
    • X-ray examination
    • Standard posterioanterior head, neck and chest
    • roentgenography showed subcutaneous emphysema and air dissection of neck (Fig 3) while chest roentgenography did not show sure signs of pneumomediastinum (Fig 4).
  • 10. Fig 1: Subcutaneous emphysema in area of right cheek and lower eyelid
  • 11. Fig 2: Subcutaneous emphysema in area of right cheek and lower eyelid
  • 12. Fig 3: Neck roentgenography: arrows indicate striped radiolucency (air) in soft tissue
  • 13. Fig 4: Chest roentgenography does not show any signs of pneumomediastinum
  • 14.
    • CASE REPORT
    • Therapy
    • Intravenous administration of fluid
    • Oxygenoterapy
    • Prophylactic antibiotics ( amoxicillin+clavulonic acid )
    • Admission course was smooth, patient’s cervical symptom subsided and the girl was discharged on the 5 th day.
  • 15. FINALE DIAGNOSIS
    • Emphysema supcutane um faciei et colli , consequentia extractionem dentis
    • T81.8
  • 16. CONCLUSION
    • In our case, a subcutaneous emphysema was initially misdiagnosed as an allergic reaction, which might have lead to errors in treatment and adverse outcome. Dentists should be aware of this rare complication if patients have such symptoms following their dental procedure.
  • 17.
    • Literatura
    • 1 .Shackelford D, Casani JA . Diffuse subcutaneous ephysema, pneumomediastinum and pneumothorax after dental extraction.Ann Emerg Med 1993;22(2):248-50
    • 2 .Schuman NJ, Owens BM, Schelton JT . Subcutaneous emphysema after restorative dental treatment. Compend Contin Educ Dent 2001;22(1):38-40
    • 3. Marýa F LP, Jose R,Salvador M . Cervical Emphysema, Pneumomediastinum, and Pneumothorax Following Self-induced Oral Injury:Report of Four Cases and Review of the Literature. Chest 2001;120:306–309
    • 4. Pynn BR, Amato D, Walker DA . Subcutaneous emphysema following dental treatment: a report two cases and review of literature. J Can Dent Assoc 1992; 58(6):496-9
    • 5. Wakoh M,Saitou C, Kitagawa H, Suga K,Ushioda T, Kuroyanagi K . Computed tomography of emphysema following tooth extraction.Dentomaxillofacial Radiology 2000;29:201 - 208. Available from: URL:http://www.nature.com/dmfr
    • 6. Ali A,Cunliffe DR , Watt-Smith SR .Surgical emphysema and pneumomediastinum complicating dental extraction. British Dental Journal 2000; 188: 589–590
    • 7. Sood T, Pullinger R .Pneumomediastinum secondary to dental extraction. Emerg Med J 2001;18:517–522. Available from: URL:http://www.emjonline.com
    • 8. Herlan DB,Landreneau Rj,Ferson PF . Massive spontaneous subcutaneous emphysema. Acute menagement with infraclavicular "blow holes". Chest 1992;102(2):503-5