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.
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 were within normal ranges.
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).
Fig 1: Subcutaneous emphysema in area of right cheek and lower eyelid
Fig 2: Subcutaneous emphysema in area of right cheek and lower eyelid
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.