IMAGES IN CARDIOTHORACIC SURGERY

Pneumomediastinum and Pneumopericardium Due to High-Speed Air Turbine Drill Used During a Dental Procedure Paul Christiaan Johannesma, MD, and Anton Vonk Noordegraaf, MD, PhD Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands

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33-year-old woman with an unremarkable medical history underwent surgical extraction of a wisdom tooth (no. 48). For this procedure, a high-speed air turbine drill was used, which inflates air in the root canal. After this procedure, the patient had mild dyspnea, and a physical examination showed right-sided facial and neck swelling. Chest radiography confirmed subcutaneous emphysema of the neck, upper thorax, and axillary regions (arrows) (Fig 1). Computed tomography of the neck and chest (Fig 2) demonstrated air in the subcutaneous and visceral spaces in the mandibular area, mediastinum (arrow), and pericardium. Standard laboratory tests produced normal results. The patient was admitted to the intensive care unit for prophylactic antibiotic treatment and spontaneous air resorption. The Address correspondence to Dr Johannesma, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands; e-mail: [email protected]

Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier

patient had an uneventful recovery and was discharged after 5 days. Six weeks later, chest radiography showed complete air resorption. In general, subcutaneous emphysema, pneumomediastinum, and pneumopericardium can be secondary to trauma, infections, maxillofacial operations, and dental surgery. The use of high-speed dental air turbine drills can lead to the introduction of air or water into soft tissue spaces through the dentoalveolar membrane in the root canal [1]. The root canal can use the sublingual and retropharyngeal spaces to communicate with the mediastinum, and this can lead to secondary infection, pneumothorax, air embolism, pneumoperitoneum, optic nerve damage (owing to orbital emphysema), and cardiac tamponade [2]. In conclusion, this case illustrates that physicians should consider pneumomediastinum and pneumopericardium when a patient experiences with dyspnea, chest and back pain, subcutaneous emphysema, or Hamman sign after a dental procedure.

References 1. Torres-Melero J, Arias-Diaz J, Balibrea JL. Pneumomediastinum secondary to use of a high speed air turbine drill during a dental extraction. Thorax 1996;51:339–40. 2. Chuong R, Boland TJ, Piper MA. Pneumomediastinum and subcutaneous emphysema associated with temporomandibular joint surgery. Oral Surg Oral Med Oral Pathol 1992;74:2–6. Ann Thorac Surg 2014;98:2232  0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.08.013

Pneumomediastinum and pneumopericardium due to high-speed air turbine drill used during a dental procedure.

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