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Emphysema after tooth problem
Introduction Application of compressed air during dental treatments can be a rare cause of profound emphysema of head and neck and beyond that.
Methods A 59-year-old female patient underwent elective dental treatment for periodontitis. She presented afterwards in our ORL department due to palpation of a crackling swelling in the face, neck and upper chest. Furthermore, the patient had pectanginous complaints. There was no dyspnoea, coughing, stridor or redness of the skin. Imaging was performed using chest x-ray and CT scan of neck and thorax. In the laboratory electrolytes, coagulation status, blood count, inflammatory values and heart enzymes were determined.
Results X-ray of the thorax revealed soft-tissue emphysema on both sides of the neck and presternal, as well as a pneumomediastinum and suspected pneumopericardium. The CT scan of neck and thorax revealed periorbital emphysema on the right side, cervical soft tissue emphysema with continuation across the ventral and dorsal thoracic wall, and mediastinal pneumomediastinum. Pneumopericardium could be excluded. The lab results did not show any pathologies. We started a prophylactic antibiotic treatment and analgesia. Within four days, the patient was symptom-free and could be discharged from inpatient care.
Conclusion A detailed risk information by the dentist is mandatory before using compressed air in dental therapies. Emphysema can usually be treated conservatively without lasting health risks. It should be considered that emphysema can lead to serious complications such as infections, dyspnoea or pneumothorax.
Article published online:
10 June 2020
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