Emphysematous Complications Following Third Molars Removal: Incidence among 10779 Surgeries and Report of Two Cases

Leandro E. Klüppel, Fernando Antonini, Alessandro Costa da Silva, Márcio de Moraes, Saulo Ellery Santos

Oral and Maxillofacial Surgery Department, School of Dentistry, Universidade Estadual de Campinas, Piracicaba, Brazil.

DOI: 10.4236/ojst.2014.47049                

Abstract

Subcutaneous emphysema is a condition that results from introduction of air into soft tissues. In head and neck, it is commonly observed following fractures of paranasal sinuses. Less frequently, it may occur during surgical procedures for tooth removal, when air from dental hand-pieces is forced into surgical site. Depending on its extension, it may involve vital spaces such as mediastinum. This specific finding may induce life-threatening situations. The aim of this article is to establish the incidence of subcutaneous emphysema among 10,779 impacted third molar surgical procedures and report the cases in which such complications had occurred. In this retrospective study, data collected from 10,779 third molar extraction procedures performed at Piracicaba School of Dentistry were evaluated for the occurrence of subcutaneous emphysema. Two cases of subcutaneous emphysema (0.018%) occurred following extraction of impacted third molars. Both were associated with mandibular tooth and related to the use of dental air hand-piece. One of the cases involved submandibular and buccal spaces while the other involved buccal and canine spaces. Regression of emphysema occurred spontaneously and postoperative recovery was uneventful. Subcutaneous emphysema following impacted third molar extractions is rare and strongly associated with the use of air turbines. Follow-up and preservation are the treatments of choice, but clinicians should be aware about the possibility of microbial spreading through facial spaces.

Keywords

Subcutaneous Emphysema, Impacted Tooth, Air Hand-Piece

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Peterson, L.J. (1998) Principles of Management of Impacted Teeth. In: Peterson, L.J. Ellis, E. Hupp, J.R. and Tucker, M.R., Eds., Contemporary Oral and Maxillofacial Surgery, Mosby, Maryland Heights, Missouri, 215-248.
[2]	Mercier, P. and Precious, D. (1992) Risks and Benefits of Removal of Impacted Third Molars. A Critical Review of the Literature. International Journal of Oral and Maxillofacial Surgery, 21, 17-27. http://dx.doi.org/10.1016/S0901-5027(05)80447-3
[3]	Bui, C.H., Seldin, E.B. and Dodson, T.B. (2003) Types, Frequencies, and Risk Factors for Complications after Third Molar Extraction. Journal of Oral and Maxillofacial Surgery, 61, 1379-1389. http://dx.doi.org/10.1016/j.joms.2003.04.001
[4]	Figueiredo, R., Valmaseda-Castellon, E., Berini-Aytes, L., et al. (2007) Delayed-Onset Infections after Lower Third Molar Extraction: A Case-Control Study. Journal of Oral and Maxillofacial Surgery, 65, 97-102. http://dx.doi.org/10.1016/j.joms.2005.10.063
[5]	Savi, A., Manfredi, M., Pizzi, S., et al. (2007) Inferior Alveolar Nerve Injury Related to Surgery for an Erupted Third Molar. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 103, e7-e9. http://dx.doi.org/10.1016/j.tripleo.2006.09.002
[6]	Muhonen, A., Iventa, I. and Ylipaavalniemi, P. (1997) Factors Predisposing to Postoperative Complications Related to Wisdom Tooth Surgery among University Students. Journal of American College Health, 46, 39-42. http://dx.doi.org/10.1080/07448489709595585
[7]	Sekine, J., Irie, A., Dotsu, H. and Inokuchi, T. (2000) Bilateral Pneumothorax with Extensive Subcutaneous Emphysema Manifested during Third Molar Surgery. A Case Report. International Journal of Oral and Maxillofacial Surgery, 29, 355-357. http://dx.doi.org/10.1016/S0901-5027(00)80051-X
[8]	Capes, J.O., Salon, J.M. and Wells, D.L. (1999) Bilateral Cervicofacial, Axillary, and Anterior Mediastinal Emphysema: A Rare Complication of Third Molar Extraction. Journal of Oral and Maxillofacial Surgery, 57, 996-999. http://dx.doi.org/10.1016/S0278-2391(99)90024-1