Tissue Emphysema

LCDR S.R. KELLY

DEFINITIONS:

Tissue emphysema = Distention of tissues by gas or air in the interstices.

Air embolism = Obstruction of a blood vessel brought about by entrance of air into the blood stream.

Tissue Emphysema

Cause:

Trauma

Surgical Procedure (Third molar extraction most common)

Non-surgical Dental Procedure (i.e. NSRCT, operative, C&B)

Note: Air may gain access to the fascial planes of the head and neck and produce a subcutaneous emphysema in any situation in which the integrity of the oral mucosa is interrupted and intraoral pressure is increased.

Case Reports:

Signs & Symptoms:

Swelling

Crepitus upon palpation

Tingling sensation (generally no pain)

Case Report:

Note: Emphysema remains in the subcutaneous connective tissue and does not spread to the deep anatomic spaces in the majority of the cases. But..........

Signs & Symptoms of Mediastinal emphysema

Sudden swelling of the neck

Difficulty breathing/swallowing

Voice sounds brassy

Characteristic crackling when palpated

Mediastinal crunching noise is heard on auscultation

Air spaces seen in AP and lateral chest radiographs

Alternate Diagnoses

Infection (gas producing bacteria)

An allergic reaction (anaphylaxis)

Hematoma

Angioedema

Esophageal rupture

Treatment: (Most patients are admitted to the hospital for observation & radiographs)

Mainly supportive

Broad spectrum antibiotics

Cough suppressants

Case Report:

Prevent:

Proper instrumentation

Correct flap design

Prudent use of N2O

Identify interrupted mucosa

Inform

Case Report: Boyle’s Law?