Pneumocephalus as result of nonsurgical peri-implantitis treatment with an air-polishing device for submucosal debridement-A case report

Background: A subcutaneous emphysema is an infrequent but potentially life-threatening complication after dental treatment involving instruments functioning with pressurized air. Emphysemata after the use of high-speed handpieces and air-syringes are well documented, however, more recently several reports on emphysemata produced by air-polishing devices during management of peri-implant biological complications have appeared. To the best of our knowledge, direct development of pneumocephalus after a dental procedure has never been reported before. Introduction of air likely contaminated with oral bacteria to the intracranial space bares the risk of developing meningitis. Case Presentation: This case report describes the spreading of a subcutaneous emphysema into the intracranial space (i.e., development of a pneumocephalus) after treatment of a peri-implantitis lesion with an air-polishing device equipped with the nozzle for submucosal debridement. A subcutaneous emphysema was noticed during the use of an air-polishing device and the subsequent computed tomography (CT) examination revealed a quite unexpected spreading of the emphysema into the intracranial space. The patient was admitted to the hospital for close surveillance, CT follow-up, and intravenous antibiotics to prevent the development of meningitis due to the introduction of air-likely contaminated with oral bacteria- into the intracranial space. After 3 days, the patient was discharged in good condition without any further complications. Conclusion: In case of an extensive subcutaneous emphysema as result of a dental procedure, a more extended radiographic examination including the mediastinal and cranial space should be considered, to assess the risk for potentially life-threatening complications.