Buccal abscess derived from subcutaneous emphysema caused by the Valsalva maneuver after oral surgery with pedicled buccal fat pad grafting

Abstract

AbstractPedicled buccal fat pad grafting is applied in a variety of oral surgeries, including the reconstruction of oral defects or the closure of oroantral communication. Pedicled buccal fat pad grafting is a well‐established and relatively safe procedure; however, it may cause complications such as swelling, hematoma and/or infection. There are few reports on the detailed cause and clinical course of these complications. This report discusses the Valsalva maneuver as a cause of complications after oral surgery with pedicled buccal fat pad grafting. A 77‐year‐old man underwent pedicled buccal fat pad grafting for oroantral communication after sequestrectomy for medication‐related osteonecrosis of the maxilla. Postoperatively, the performance of the Valsalva maneuver during defecation caused facial subcutaneous emphysema, hematoma and buccal abscess formation. The abscess could not be treated by antibiotics alone, and required surgical drainage. Prominent subcutaneous emphysema is associated with bleeding due to blood vessel damage, and may cause a large hematoma, especially in patients receiving antithrombotic therapy. Hematomas are susceptible to infection, and infections in the buccal space are often severe due to the tissue continuity in deep spaces. Therefore, buccal abscesses after pedicled buccal fat pad grafting require surgical drainage. This case report suggests that performing the Valsalva maneuver during defecation may cause complications after pedicled buccal fat pad grafting. Patients should be informed that the Valsalva maneuver could lead to serious complications, and that all types of the Valsalva maneuver should be avoided postoperatively.