Iatrogenic subcutaneous emphysema of the cervicofacial and mediastinal regions

Objectives. To alert colleagues to the importance of prompt diagnosis of subcutaneous emphysema. Materials and methods. For radiological diagnosis the authors suggest computed tomography (CT) or digital volumetric tomography. The patient was treated with Augmentin (R) 2,2 g (amoxicillin + clavulanic acid) and CoAmoxi- Mepha 625 mg (R) (amoxicillin + clavulanic acid) to prevent mediastinitis. Results and conclusions. Subcutaneous emphysema is a very unusual complication of dental therapy. The case reported here occurred after restoration of a class V cavity done with a contra-angle handpiece. It involved subcutaneous emphysema extending from the face and neck all the way down to the mediastinum. Dentists and dental hygienists should be aware of the risk of this type of complication when drills or air flow instruments are used. Prompt diagnosis is important. Subcutaneous emphysema presents with soft, sometimes painless tumefaction that produces a crackling sensation when palpated. The clinical diagnosis can be confirmed radiographically. Treatment is limited to analgesic and antibiotic therapy, and symptoms disappear in about 3-10 days. When the emphysema extends into the mediastinal region, evaluation in a specialist center is advisable to prevent the development of mediastinitis, which can be lethal if not treated. In the case reported here, clinical examination 5 days after onset revealed complete reabsorption of the emphysema and no complications. Repeat CT 27 days after onset revealed no residual subcutaneous air.