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Review
. 2020 Aug 18;49(1):61.
doi: 10.1186/s40463-020-00455-0.

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

Adnan Busuladzic  1 , Melissa Patry  1 , Laurent Fradet  1 , Valérie Turgeon  2 , Marie Bussieres  3
Affiliations
Review

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

Adnan Busuladzic et al. J Otolaryngol Head Neck Surg. .

Abstract

Background: Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections.

Case presentation: We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces.

Conclusion: As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.

Keywords: Dental restoration; Necrotizing fasciitis; Pneumomediastinum; Subcutaneous emphysema.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Initial CXR on arrival. a Antero-posterior view - important pneumomediastinum b) Lateral view - suspected pneumopericardium (white arrow). Both views show diffuse cervical emphysema
Fig. 2
Fig. 2
Cervicothoracic CT on arrival. a through f) Extensive emphysema, involving almost every deep neck and mediastinal spaces
Fig. 3
Fig. 3
Postoperative day 2 CXR.Postero-anterior view showing significant improvement of subcutaneous emphysem
See this image and copyright information in PMC

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