Abstract
Subcutaneous emphysema is a well-known and recognized complication in oral surgery, due to high pressure rotating instrument use, mostly related to impacted tooth surgery. Although root canal treatment in endodontic therapy is considered as a safe and standard procedure, affected by a low incidence of complication, subcutaneous emphysema due to the choice of mechanical tools or as a consequence of the use of air stream to dry the operating field should be considered as a potential cause. The air can spread through soft tissue from the apex or from an iatrogenic root perforation, suddenly leading to this unusual complication. It is very important for a dental practitioner to promptly identify the adverse event and to know how to manage this situation. We report a case of a 57-year-old woman with immediate subcutaneous cervicofacial emphysema after root canal therapy of the right inferior second premolar and its management. A brief review of the literature is also displayed.
Highlights
Improper root canal therapy (RCT) can lead to subcutaneous emphysema as iatrogenic complication, along with periodontal treatment, tooth extraction and restorative dentistry [1]
As stated by the valuable paper by Fasoulas et al [21], subcutaneous emphysema (SCE) is more frequent in females than in males, with a ratio of 2:1, this was confirmed in our database
In most of the articles cited in this review, the endodontic procedure which leads to soft tissue swelling is initial RCT (78%), while 14% happens during non-surgical RCT and 5% is linked to endodontic surgery
Summary
Improper root canal therapy (RCT) can lead to subcutaneous emphysema as iatrogenic complication, along with periodontal treatment, tooth extraction and restorative dentistry [1]. The emphysema in dentistry can involve the facial area, up to the orbital region [3] and the neck region [4], but there are a few cases of mediastinal emphysema [5] All these complications may present at the same time [6], creating a challenge for their management by dentists. Emphysema is a possible cause of infection in the deeper spaces occurring in communication environments with a microbial load, such as the oral cavity, and underlying sterile compartments. Literature on this topic offers a case of loss of vision due to optic nerve damage [8]. The common presentation of SCE is a sudden swelling of variable extent that generates crepitus if pressed by the fingers
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