https://doi.org/10.5125/jkaoms.2018.44.5.212
J Korean Assoc Oral Maxillofac Surg 2018; 44(5): 212~219
Subcutaneous emphysema related to dental procedures
Cheol-Hee Jeong1, Seungkyu Yoon1, Seung-Won Chung2, Jae-Young Kim1, Kwang-Ho Park1, Jong-Ki Huh1
1Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul,
2Department of Dentistry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
Jong-Ki Huh
Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-ro, Gangnamgu, Seoul 06273, Korea
TEL: +82-2-2019-4560 FAX: +82-2-3463-4052
E-mail: omshuh@yuhs.ac
ORCID: https://orcid.org/0000-0002-7381-3972
Received July 6, 2018; Revised July 16, 2018; Accepted July 16, 2018.; Published online October 31, 2018.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Objectives: The objective of this study was to analyze 11 cases of subcutaneous emphysema associated with dental procedures from a single hospital and discuss approaches for accurate diagnosis and treatment of the condition.
Materials and Methods: The medical records of 11 patients who were treated for subcutaneous emphysema related to dental procedures between January 2009 and April 2017 were analyzed retrospectively. Patients with subcutaneous emphysema within the facial area or that spread to the neck and beyond, including the facial region, were assigned to two groups and compared in terms of age, sex, and durations of antibiotic use, hospitalization, and follow-up until improvement. The correlation between location of the origin tooth and range of emphysema spread was analyzed.
Results: The average durations of antibiotic use during conservative treatment and follow-up until improvement were 8.55 days (standard deviation [SD], 4.46 days) and 1.82 weeks (SD, 1.19 weeks), respectively. There was no intergroup difference in duration of antibiotic use (P=0.329) or follow-up (P=0.931). Subcutaneous emphysema was more common after dental procedures involving the maxilla or posterior region than after those involving the mandible or anterior region. There was no significant difference in air distribution according to location of the air orifice (maxilla, mandible, or both; P=0.106).
Conclusion: Upon adequate conservative treatment accompanied by prophylactic antibiotic treatment considering the risk of infection, patients showed signs of improvement within a few days or weeks. There was no significant difference in treatment period between patients with subcutaneous emphysema localized to the facial region and those with subcutaneous emphysema spreading to the neck or beyond. These findings need to be confirmed by analysis of additional cases.
Keywords: Subcutaneous emphysema, Dental care, Mediastinal emphysema, Cervicofacial, Iatrogenic disease
Figures
Fig. 1. Serial radiographs of the neck in lateral view. A. Hospital day 1: Soft-tissue swelling and presence of air in subcutaneous tissues of the submandibular space, anterior neck, and retropharyngeal space (arrows). B. Hospital day 2: Air in the submandibular space and middle region of the neck had been partially absorbed (arrows), while air remaining above the scapula could still be observed (dotted arrow). C. Hospital day 3. D. Last visit (9 days after onset): Air in the mandibular and cervical regions had almost disappeared (arrows).
Cheol-Hee Jeong et al: Subcutaneous emphysema related to dental procedures.

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