Images in Clinical Medicine

Prevertebral Emphysema after a Dental Procedure

Kumar Sujeet, M.D., and Stuti Shankar, M.D.

N Engl J Med 2007; 356:173January 11, 2007

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A 47-year-old woman with diabetes was seen in the emergency room with difficulty swallowing, bilateral chest pain, and a foreign-body sensation in her throat. Earlier that day, she had undergone a root canal under local anesthesia. Her symptoms were initially attributed to an allergic reaction to the anesthetic. Examination showed crepitus in her neck. A radiograph of the neck showed emphysema with prevertebral air in the cervical soft tissues. The likely mechanism for the introduction of air was injection by means of a high-speed dental drill through the soft tissue adjacent to the roots of the lower molars. Surgical procedures, especially those involving the lower third molar teeth, may confer a predisposition to the development of soft-tissue emphysema and even a fatal air embolism when air-cooled dental turbines are used. As this radiograph shows, the cervical prevertebral space (arrows) connects to the mediastinum, which may permit gas or microorganisms from the oral cavity to enter the mediastinum. This patient was monitored closely and had a spontaneous recovery.

Kumar Sujeet, M.D.
Stuti Shankar, M.D.
Good Samaritan Hospital, Baltimore, MD 21239
kumar.sujeet@medstar.net

Citing Articles (5)

Citing Articles

1. 1

   Lokman Onur Uyanık, Melek Aydın, Oğuz Buhara, Aysa Ayalı, Atakan Kalender. (2011) Periorbital emphysema during dental treatment: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 112:6, e94-e96
   CrossRef

2. 2

   H.-L. Hsu, C.-C. Chang, K.-L. Liu. (2011) Subcutaneous emphysema after dental procedure. QJM 104:6, 545-545
   CrossRef

3. 3

   Yemi Kim, Myung-Rae Kim, Sun-Jong Kim. (2010) Iatrogenic pneumomediastinum with extensive subcutaneous emphysema after endodontic treatment: report of 2 cases. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 109:2, e114-e119
   CrossRef

4. 4

   Ikuko Arai, Takayuki Aoki, Hiroshi Yamazaki, Yoshihide Ota, Akihiro Kaneko. (2009) Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 107:4, e33-e38
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5. 5

   Giuseppina Magni, Carmela Imperiale, Giovanni Rosa, Roberto Favaro. (2008) Nonfatal Cerebral Air Embolism After Dental Surgery. Anesthesia & Analgesia 106:1, 249-251
   CrossRef