1216

BRITISH MEDICAL JOURNAL

5 NOVEMBER 1977

Surgical emphysema during dental treatment

sequences'5 but may in exceptional circumstances extend to the mediastinum,6 or cause air embolism.' C M SCULLY SIR,-Further to Dr J H B Williams's letter (8 October, p 960) and request for further Arkley, information, his interesting case is not Herts unprecedented. Indeed, one wonders how Shovelton, D S, British Dental Jfournal, 1957, 102, many cases, possibly of a minor degree, go 105. T, J7ournal of the American Dental Associaunreported, with the use of compressed air 2Feinstone, tion, 1971, 83, 1309. as a power source for dental instruments 3Bhat, K S, Oral Surgery, Oral Medicine and Oral Pathology, 1974, 38, 305. having become a more common practice. J E G, British Journal of Oral Surgery, 1975, Norton and I described a case seen in 1966 4Walker, 13, 98. H C, and Kay, L W, The Prevention of in an article-"Surgical Emphysema Occurr- 5Killey, Complications in the Dental Surgery, p 56. Edinburgh ing During Conservative Dental Surgery."l and London, Livingstone, 1969. Llovd, R E, British DentalJournal, 1975, 138, 393. psychiatric inpatient 7Rickles, 54-year-old My N H, and Joshi, B A, Journal of she American received dental treatment and developed Dental Association, 1963, 67, 397. definite emphysema due to entry of air around the gingival crevice while that part of the preparation was carried out which involved grinding of tooth substance below the level SIR,-Further to Dr J H B Williams's letter of the gum margin. It was reported that (8 October, p 960), the production of surgical spectacularly, within fifteen seconds, the emphysema following the introduction of lower left eyelid slowly swelled up to such an compressed air to the tissues during dental extent as to close the patient's eye, with the practice is, I regret, no new hazard. Each year swelling extending over the left side of the many of my oral surgical colleagues will see face and neck, and superficial crepitus being such cases referred for management from easily elicited. She complained of fullness dental practitioners. At this hospital three in her throat on swallowing, but there was no such cases have been seen and treated in the dyspnoea, pain, or tissue discoloration. last three weeks. This, of course, does not Possibilities such as an underlying allergic include the facial and neck surgical emphysema reaction or partial angioneurotic oedema were that follows injudicious nose blowing after rapidly excluded in view of the likely pre- zygomatic complex and other mid-third facial cipitating cause, and the x-ray confirmation injuries. The accompanying photographs clearly of unilateral emphysema demonstrated over the left side of the face and neck, extending from show the significant extension of air within the the level of the lobe of the ear down to the left tissues of two patients following the application of C6. There was no evidence of mediastinal of a dental compressed air syringe to the extension. The patient, being reassured by upper labial sulcus (fig 1) and to the root continued close supervision, having minimal canal of an upper tooth (fig 2). This was discomfort, and possibly being quietly gratified done ostensibly to dry an operative site. at being the centre of interest, showed no Perforation of bone adjacent to root apices exacerbation of her neurotic tendencies, but allows air escape to the facial tissues. The was calmly co-operative. The condition settled onset of swelling is dramatic, painful, and down gradually and completely over a period frightening, occurring within a second or two. The significance of the event is the almost of five days: antibiotics were held in reserve but not given as at no time was there any routine entrapment of air within the periorbital tissues and this is often accompanied by ptosis evidence of infection. Interestingly, the literature extends back and diplopia. The air can be shown on a to 1900, with Turnbull describing a case of standard occipitomental radiograph as relative dental surgical emphysema, the patient being orbital radiolucency. Extension to the suba Naval bugler who pumped air into his mandibular and lateral pharyngeal spaces also facial tissues after the extraction of a bicuspid.2 occurs, and indeed this happened in the patient Other authors have reported similar occur- shown in fig 1. The clinical presence of rences after oral surgery associated, respectively, with nose-blowing, coughing, and

spitting.5 M SEGAL Halifax General Hospital, Halifax, West Yorkshire Segal, M, and Norton, H D, Dental Practitioner, 1967, 17, No 8, 274. ' Turnbull, A A, British MedicalyJournal, 1900, 1, 1131. 3 Stockdale, C R, Oral Surgery, 1958, 11, 135. ' Brown, C J, jun, J7ournal of the Kansas State Dental Association, 1950, 34, 94. Oswalt, T G, Journal of the Mississippi Dental Association, 1963, 19, 12.

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SIR,-Dr J H B Williams (8 October, p 960) reports a case of surgical emphysema following dental treatment. Although uncommon, this is not a rare event,' and has been described following a variety of dental procedures, including especially the use of compressed air in an air turbine dental drill or in a syringe.2 Further cases have been recorded after the use of hydrogen peroxide to irrigate root canals,3 _ _ and we have seen a case that resulted from Ve trumpet playing immediately following a dental extraction. The condition usually resolves spontaneously with no serious con_

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Surgical emphysema during dental treatment.

1216 BRITISH MEDICAL JOURNAL 5 NOVEMBER 1977 Surgical emphysema during dental treatment sequences'5 but may in exceptional circumstances extend to...
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