Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
Recently I received an anxious telephone call from a dentist concerned about a patient's facial swelling. The dentist's anxiety was created by the sudden and significant swelling of his patient's cheek and eyelids while he was performing "routine" dental restorations. This is the second telephone call I have received in as many months for this situation. In both cases the dentists involved, as well as their patients, were very, very, anxious. Surgical emphysema- the abnormal presence of air or gas in body tissue or body spaces--can be caused by procedures that introduce air into the soft tissues. In dentistry, the use of air-driven handpieces and high speed water coupled equipment has been associated with iatrogenic subcutaneous surgical emphysema. Although this complication is rare, its frequency is increasing. Most cases resolve spontaneously, but they can be life threatening.
A case recently reported in the J. of Otolaryngology discusses a 56 year old female patient who developed mild facial swelling following restorations being placed in the mandibular premolar area. No treatment was initiated by her dentist at that time, nor was she given any special instructions, and the patient was sent home. The facial swelling increased and the woman began to develop difficulty breathing and dysphagia. When the patient was seen at the hospital 12 hours later; facial swelling was noted from the eyelid down to the supraclavicular region including the chest. Crepitus was noted and an x-ray of the neck revealed diffuse surgical emphysema in the neck's soft tissue planes. The patient was admitted for observation and discharged the next day when the swelling had mostly resolved. The onset of swelling associated with surgical emphysema is sudden. Crepitus or "crackling" is typically noted upon palpation of affected tissues. Crepitus does not occur with hematoma nor angioedema.
In this more recent instance of surgical emphysema, I recommended to the dentist that he remain calm and to assure his patient that the swelling would resolve spontaneously. In the event of breathing difficulties or dysphagia hospital treatment is indicated. A telephone call by the general dentist the next morning revealed a full and unremarkable recovery by the patient.
Surgical emphysema is caused by air forced into the soft tissues or tissue planes. If sudden swelling occurs after treatment, palpate the tissues; if crepitus is present, surgical emphysema is likely. Remain CALM and reassure the patient. Management is usually conservative.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery