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Surgical emphysema and pneumomediastinum after coronectomy
ARTICLE IN PRESS
YBJOM-4523; No. of Pages 2
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
Short communication
Surgical emphysema and pneumomediastinum after coronectomy C. Wong, J. Collin ∗ , C. Hughes, S. Thomas Rooftop Offices, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS2 1LY, United Kingdom Accepted 10 May 2015
Abstract We report a case of surgical emphysema and pneumomediastinum after coronectomy of the lower right third molar. Surgical emphysema related to dental extractions is well- reported, but not after coronectomy. This case emphasises the importance of avoiding the use of air turbine drills during oral surgery. © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Oral surgery; Coronectomy
Case report A previously healthy, 48-year-old woman was referred by a community oral surgeon to the on-call oral and maxillofacial (OMFS) team with bilateral cervicofacial swelling immediately after coronectomy of the lower right third molar. The procedure had been difficult and a high-speed air turbine drill had been used for decoronation. Examination showed a bilateral, tender swelling from the periorbital regions to the clavicles, which was associated with mild erythema and crepitus (Fig. 1). Eye opening was impaired, but visual acuity and eye movements were not affected. Vital signs were unremarkable and the airway was not compromised. A plain chest radiograph confirmed subcutaneous and tissue space emphysema with pneumomediastinum (Fig. 2). She was reviewed by the cardiothoracic surgery team who agreed that no intervention was required. After being ∗
Corresponding author. E-mail addresses: [email protected] (C. Wong), [email protected] (J. Collin), [email protected] (C. Hughes), [email protected] (S. Thomas).
monitored in the Emergency Department for 6 hours, she was discharged with simple analgesia and was advised to avoid Valsalva manoeuvres and to return immediately if respiratory symptoms developed. At review one week later the swelling had resolved (Fig. 3). She still had mild erythema around her neck and the site of the coronectomy was painful. Further follow-up was arranged in case extraction of the retained roots became necessary.
Discussion Coronectomy of third molars has gained in popularity over the past decade for teeth that are close to the inferior alveolar nerve. Potential complications include pain, infection, and damage to the nerve.1 The remaining roots may also require removal if they subsequently erupt into the oral cavity. To our knowledge, surgical emphysema, which is a wellknown complication of dental extractions, has not previously been reported after coronectomy. Emphysema within subdermal or deep fascial planes is usually iatrogenic, but can occur after trauma or infection.2 In this case air had also been
http://dx.doi.org/10.1016/j.bjoms.2015.05.008 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Wong C, et al. Surgical emphysema and pneumomediastinum after coronectomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.05.008
YBJOM-4523; No. of Pages 2
2
ARTICLE IN PRESS C. Wong et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
Fig. 3. Patient at one-week review, with swelling resolved (published with the patient’s consent. Fig. 1. Patient on presentation with bilateral periorbital and cervical swelling (published with the patient’s consent).
There is the potential for infection from contaminated air from the turbine and oral bacteria, so close review is appropriate. In this case, as the patient was well and had minimal symptoms, she was discharged without prophylactic antibiotics.
Conflict of interest We have no conflicts of interest.
Ethics statement/confirmation of patient permission We confirm that the patient has given permission for images to be published.
References Fig. 2. Chest radiograph showing surgical emphysema and pneumomediastinum, most evident as widening of the pericardial space on the left cardiac border.
introduced into the mediastinum through the parapharyngeal and retropharyngeal spaces. Although pneumomediastinum usually resolves spontaneously in 3 to 10 days,3 potential complications include mediastinitis, cardiac tamponade, obstruction of the airway, simple or tension pneumothorax, and pneumoperitoneum.4
1. Leung YY, Cheung LK. Coronectomy of the lower third molar is safe within the first 3 years. J Oral Maxillofac Surg 2012;70:1515–22. 2. Yang SC, Chiu TH, Lin TJ, et al. Subcutaneous emphysema and pneumomediastinum secondary to dental extraction: a case report and literature review. Kaohsiung J Med Sci 2006;22:641–5. 3. McKenzie WS, Rosenberg M. Iatrogenic subcutaneous emphysema of dental and surgical origin: a literature review. J Oral Maxillofac Surg 2009;67:1265–8. 4. Ali A, Cunliffe DR, Watt-Smith SR. Surgical emphysema and pneumomediastinum complicating dental extraction. Br Dent J 2000;188:589–90.
Please cite this article in press as: Wong C, et al. Surgical emphysema and pneumomediastinum after coronectomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.05.008
YBJOM-4523; No. of Pages 2
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
Short communication
Surgical emphysema and pneumomediastinum after coronectomy C. Wong, J. Collin ∗ , C. Hughes, S. Thomas Rooftop Offices, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS2 1LY, United Kingdom Accepted 10 May 2015
Abstract We report a case of surgical emphysema and pneumomediastinum after coronectomy of the lower right third molar. Surgical emphysema related to dental extractions is well- reported, but not after coronectomy. This case emphasises the importance of avoiding the use of air turbine drills during oral surgery. © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Oral surgery; Coronectomy
Case report A previously healthy, 48-year-old woman was referred by a community oral surgeon to the on-call oral and maxillofacial (OMFS) team with bilateral cervicofacial swelling immediately after coronectomy of the lower right third molar. The procedure had been difficult and a high-speed air turbine drill had been used for decoronation. Examination showed a bilateral, tender swelling from the periorbital regions to the clavicles, which was associated with mild erythema and crepitus (Fig. 1). Eye opening was impaired, but visual acuity and eye movements were not affected. Vital signs were unremarkable and the airway was not compromised. A plain chest radiograph confirmed subcutaneous and tissue space emphysema with pneumomediastinum (Fig. 2). She was reviewed by the cardiothoracic surgery team who agreed that no intervention was required. After being ∗
Corresponding author. E-mail addresses: [email protected] (C. Wong), [email protected] (J. Collin), [email protected] (C. Hughes), [email protected] (S. Thomas).
monitored in the Emergency Department for 6 hours, she was discharged with simple analgesia and was advised to avoid Valsalva manoeuvres and to return immediately if respiratory symptoms developed. At review one week later the swelling had resolved (Fig. 3). She still had mild erythema around her neck and the site of the coronectomy was painful. Further follow-up was arranged in case extraction of the retained roots became necessary.
Discussion Coronectomy of third molars has gained in popularity over the past decade for teeth that are close to the inferior alveolar nerve. Potential complications include pain, infection, and damage to the nerve.1 The remaining roots may also require removal if they subsequently erupt into the oral cavity. To our knowledge, surgical emphysema, which is a wellknown complication of dental extractions, has not previously been reported after coronectomy. Emphysema within subdermal or deep fascial planes is usually iatrogenic, but can occur after trauma or infection.2 In this case air had also been
http://dx.doi.org/10.1016/j.bjoms.2015.05.008 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Wong C, et al. Surgical emphysema and pneumomediastinum after coronectomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.05.008
YBJOM-4523; No. of Pages 2
2
ARTICLE IN PRESS C. Wong et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
Fig. 3. Patient at one-week review, with swelling resolved (published with the patient’s consent. Fig. 1. Patient on presentation with bilateral periorbital and cervical swelling (published with the patient’s consent).
There is the potential for infection from contaminated air from the turbine and oral bacteria, so close review is appropriate. In this case, as the patient was well and had minimal symptoms, she was discharged without prophylactic antibiotics.
Conflict of interest We have no conflicts of interest.
Ethics statement/confirmation of patient permission We confirm that the patient has given permission for images to be published.
References Fig. 2. Chest radiograph showing surgical emphysema and pneumomediastinum, most evident as widening of the pericardial space on the left cardiac border.
introduced into the mediastinum through the parapharyngeal and retropharyngeal spaces. Although pneumomediastinum usually resolves spontaneously in 3 to 10 days,3 potential complications include mediastinitis, cardiac tamponade, obstruction of the airway, simple or tension pneumothorax, and pneumoperitoneum.4
1. Leung YY, Cheung LK. Coronectomy of the lower third molar is safe within the first 3 years. J Oral Maxillofac Surg 2012;70:1515–22. 2. Yang SC, Chiu TH, Lin TJ, et al. Subcutaneous emphysema and pneumomediastinum secondary to dental extraction: a case report and literature review. Kaohsiung J Med Sci 2006;22:641–5. 3. McKenzie WS, Rosenberg M. Iatrogenic subcutaneous emphysema of dental and surgical origin: a literature review. J Oral Maxillofac Surg 2009;67:1265–8. 4. Ali A, Cunliffe DR, Watt-Smith SR. Surgical emphysema and pneumomediastinum complicating dental extraction. Br Dent J 2000;188:589–90.
Please cite this article in press as: Wong C, et al. Surgical emphysema and pneumomediastinum after coronectomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.05.008