Periorbital emphysema following dental procedure: A case report with literature review

Abstract

We aimed to present a case of periorbital emphysema after tooth extraction in private dental practice. A 20-year-old female patient with the left maxillary first molar tooth extracted under local anesthesia was referred to the ophthalmologist with complaints of swelling and pain around the left eye 6 hours after the procedure. The best visual acuity was logMAR 0.0 in both eyes on visual examination. In the slit-lamp examination, there was periorbital swelling in the left eye, free eye movement, and a light reaction. The right eye followed naturally. Fundus examination of the bilateral optic nerve was normal. On palpation, crepitation was detected in the left periorbital region. A rapid assessment of airway obstruction was made. Diffuse air was observed in the left orbital soft tissue in orbita computed tomography. Prophylactic penicillin-derived antibiotics and nonsteroidal antibiotics were started. The light reaction was followed closely. Periorbital swelling decreased 24 hours after the procedure. During the surgical removal of impacted teeth, air through the air-operated handpiece may cause spread from the periapical region to the periorbital space along the subperiosteal region and fascial planes. Care should be taken to avoid this rare complication after dental procedures.