Extensive subcutaneous emphysema after exodonty of molar third parties: Case report





Subcutaneous emphysema; Intraoperative complications; Tooth extraction.


Introduction: Subcutaneous emphysema is an accident where the forced introduction of air into the tissues occurs, which in dentistry can appear after the use of a high-speed pen or triple syringe. The swelling associated with emphysema can be mistaken for bruising, allergies or infections. The differential diagnosis is often related to the presence of crackles on palpation, associated or not, with pain. Treatment is prophylactic and palliative, since the problem tends to resolve spontaneously. Objective: To report a clinical case of subcutaneous emphysema and extraction of third molars, discussing the importance of differential diagnosis to guide the treatment of this complication. Case report: A 22-year-old female patient attended the oral and maxillofacial surgery service of a public hospital in Recife-PE, complaining of pain in the lower left third molar region. During the surgical procedure, it was necessary to use a high-speed pen to perform osteotomy and odontosection of tooth 38. At the end of the surgery, there was an increase in volume in the left periorbital region, compatible with subcutaneous emphysema. After 7 days postoperatively, spontaneous resolution of emphysema was observed. Discussion: According to the current literature, after the emphysema is already under a dermal layer, the air may remain at the surgery site or continue to spread along the facial spaces, depending on the permanence of the air jet. Conclusion: The correct diagnosis of subcutaneous emphysema was effective in ruling out other complications, guiding the management of the reported case, in addition to preventing the emphysema from evolving to an infection involving the cervicofacial or thoracic region.


Barkdull, T. (2003). Pneumothorax during dental care. Journal of the American Board of Family Medicine. 16: 165–9. https://doi.org/10.3122/jabfm.16.2.165

Cardo, V., Mooney, J, & Stratigos, G. (1972). Iatrogenic dental-air emphysema: report of case. Journal of the American Dental Association. 85:144-7. https://doi.org/10.14219/jada.archive.1972.0283

Guest, P., & Henderson, S. (1991). Surgical emphysema of the mediastinum as a consequence of attempted extraction of a third molar tooth using an air turbine drill. Brazilian Dental Journal.171:283-4. 10.1038/sj.bdj.4807693

Gulati, A., Baldwin, A., & Intosh, I. (2008). Krishnan, A. Pneumomediastinum, bilateral pneumothorax, pleural effusion, and surgical emphysema after routine apicectomy caused by vomiting. Journal of the British Association of Oral and Maxillofacial Surgeons. 46(2):136-7. 10.1016 / j.bjoms.2006.11.008

Heyman, S., & Babayof, I. (1995). Emphysematous Complications In Dentistry, 1960-1993: An Illustrative Case And Review Of The Literature. Quintessence International. 26: 535–43. https://pubmed.ncbi.nlm.nih.gov/8602428/

Huang, I., Chen, C., Chang, S., Yang, C., Chen, C., & Chen, C. (2007). Surgical management of acci¬dentally displaced mandibular third molar into the pterygomandibular space: a case report. The Kaohsiung Journal of Medical Sciences, 23: 370-4. 10.1016 / S1607-551X (09) 70424-3

Jeong, C., Yoon, S., Chung, S., Kim, J., Park, K., & Huh, J. (2018). Subcutaneous emphysema related to dental procedures. J Korean Association of Oral and Maxillofacial Surgeons. 44(5):212-219. 10.5125 / jkaoms.2018.44.5.212

Kim, Y., Kim, M., & Kim, S. (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:e114-9. 10.1016 / j.tripleo.2009.09.013

Kiyokawa, H., Yonemaru, M., Horie, S., Ichinose, Y., & Toyama, K. (1995). Frequency analysis of crackles recorded with a stethoscope-equipped recorder. Nihon Kyobu Shikkan Gakkai Zasshi. 33(12):1341-7. https://pubmed.ncbi.nlm.nih.gov/8821985/

Kung, J., Chuang, F., Hsu, K., Shih, Y., Chen, C., & Huang, I. (2009). Extensive subcutaneous emphysema after extraction of a mandibular third molar: a case report. The Kaohsiung Journal of Medical Sciences. 25:562-6 10.1016 / S1607-551X (09) 70550-9

Mcgrannahan, W. (1965). Tissue space emphysema from an air turbine handpiece. Journal of the American Dental Association. 884-885. https://www.aapd.org/globalassets/media/publications/archives/wright-13-02.pdf

Medeiros, B. (2018). Subcutaneous emphysema, a different way to diagnose. Revista da Associação Médica Brasileira, 64(2):159-163. https://doi.org/10.1590/1806-9282.64.02.159.

Pereira, A., Shitsuka, D., Parreira, F., & Shitsuka, R. (2018). Metodologia da pesquisa científica. UFSM. https://repositorio.ufsm.br/bitstream/handle/1/19110/Curso_Lic-Ed-Esp_Did%C3%A1tica-Geral.pdf?sequence=1&isAllowed=y

Rosenberg, M., Phero, J., & Giovannitti, J. (2013). Management of allergy and anaphylaxis during oral surgery. Oral and Maxillofacial Surgery Clinics of North America. 25: 401–406. 10.1016 / j.coms.2013.04.001

Shackelford, D., & Casani, J. (1993). Enfisema subcutâneo difuso, pneumomediastino e pneumotórax após extração dental. Annals of emergency medicine. 22 : 248–50. https://doi.org/10.1590/S0034-72992005000100017

Shovellon, D. (1957). Surgical emphysema as a coinplication of dental operations. Brazilian Dental Journal. 102:125-129. http://scielo.isciii.es/pdf/medicorpa/v12n1/17.pdf

Smeke, L., Sormani, Q., & Kfouri, F. (2015). Enfisema subcutâneo associado à utilização de caneta de alta rotação durante remoção de enxerto – relato de caso. Full Dentistry in Science. 6(23):275-278. https://www.researchgate.net/publication/281491901_Subcutaneous_emphysema_associated_with_the_use_of_high-speed_drill_during_graft_harvesting_-_case_report

Snyder, M., & Rosenberg, E. (1977). Subcutaneous Emphysema during Periodontal Surgery: Report of a Case. Journal of Periodontology. 48:790-1. https://doi.org/10.1902/jop.1977.48.12.790

Steelman, R., & Johannes, P. (2007). Subcutaneous emphysema during restorative dentistry. International journal of paediatric dentistry. 17:228-9. 10.1111 / j.1365-263X.2006.00814.x

Turnbull A. (2007). A remarkable coincidence in dental surgery. Br Med J., 1:1131. 10.1111 / j.1365-263X.2006.00814.x



How to Cite

SANTOS, A. J. F. dos; AIRES, C. C. G. .; FIGUEIREDO, E. L. de .; VASCONCELOS, B. C. do E. Extensive subcutaneous emphysema after exodonty of molar third parties: Case report. Research, Society and Development, [S. l.], v. 10, n. 4, p. e37310414311, 2021. DOI: 10.33448/rsd-v10i4.14311. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/14311. Acesso em: 16 may. 2021.



Health Sciences