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A3244 - Delayed Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax Post Dental Extraction
Author Block: S. Zaigham1, M. Doraiswamy1, P. K. Dy1, C. D. Patton2; 1Internal Medicine, Monmouth Medical Center, Long Branch, NJ, United States, 2Monmouth Pulm Consultants, Eatontown, NJ, United States.
Subcutaneous emphysema, pneumomediastinum and pneumothorax occasionally occur following surgical procedures involving the neck and chest but are rare findings after dental extraction. These complications usually occur few hours to a day after. This abstract presents a delayed case post-procedure. A 48-year-old male presented to Emergency Department with complains of progressive facial swelling and a day of voice change. Eleven days prior, patient had right second lower molar tooth extraction and was discharged on pain medications and erythromycin. Later in the day, he noticed facial swelling, cough and odynophagia. His symptoms worsened and on the day of presentation, noticed a change in the quality of his voice. He denied having fever, chills or chest pain, but had some dyspnea. Physical examination showed Blood pressure of 124/83, Heart rate of 75 beats per minute, Respiratory rate of 18 breaths per minute with 95% oxygen saturation on 2 Liters Nasal cannula. He had right lower facial, bilateral neck and upper chest swelling with crepitus on palpation. Trachea was in midline. Laboratory showed leukocytosis of neutrophil predominance. His neck radiograph showed extensive subcutaneous emphysema. Chest Computed tomography (CT) scan showed extensive subcutaneous emphysema across maxillary, mandibular and cervical fascial planes, extensive pneumomediastinum and left-sided apical pneumothorax. Management consisted of continuous cardiac and respiratory monitoring and Intravenous ampicillin-sulbactam. His odynophagia and subcutaneous emphysema resolved, and was discharged 3 days after on amoxicillin-clavulanate. Pneumomediastinum, subcutaneous emphysema and pneumothorax are conditions characterized by presence of air in mediastinum, subcutaneous area and pleural space, respectively. Air forced under pressure and communication between oral cavity and subcutaneous tissue are factors that lead to these complications. The 1st, 2nd, and 3rd molar roots are connected to the sublingual and submandibular area. Hence, high-speed air drill use during dental procedures may lead to these complications. Patients may be asymptomatic, but presentations ranging from dysphagia to dyspnea and retrosternal chest pain have been reported depending upon the amount of air in the tissues. Occasionally, pneumopericardium can occur. Respiratory and cardiac statuses should be monitored. Antibiotic is necessary as infections can arise when fascial planes are exposed that may lead to mediastinitis. Preventively, compressed air should be used cautiously during dental procedures. In conclusion, facial swelling, dysphagia or dyspnea should not be ignored post dental procedure and should be worked up to rule out such complications.