Subcutaneous Emphysema Following Molar Tooth Extraction: A Case Report

The surgical extraction of third molars is the most frequent surgical procedure in oral surgery. Subcutaneous emphysema is an uncommon clinical condition caused by forceful injection of air into the loose connective tissue below the dermal layer, and mostly is the result of using a high-speed air-driven hand piece during surgical tooth extraction. Subcutaneous emphysema is seen mostly in the third and fifth decade of life and in the right mandibular wisdom tooth extraction surgery site. Emphysema can spread to deep spaces such as infratemporal, pterygomandibular, masseteric, lateral or retropharyngeal or mediastinum. This study presents a case report of subcutaneous emphysema occurred during the third molar extraction by using an air-driven hand piece in a 28-year-old female patient. This study has no specific ethical considerations. Informed consent was obtained from the patient to use her information and images. Case management and the issues relative to the diagnosis and prevention of this surgical complication are discussed. Trismus was present with maximum opening of about 30 mm, and no signs of dysphagia and dyspnea were reported. Patient was administered 4 million units of penicillin Intravenous (IV) every 4 hours, metronidazole 500 mg IV every 8 hours solved in 100-cc normal saline infused slowly, and rinsing mouth with 0.2% chlorhexidine every 8 hours. The patient was hospitalized for 36 hours and treated with antibiotic regimen, and then followed up for day 5 until complete resolution of swelling, maximum opening up to 50 mm, and lack of crepitation. No other local, systemic and infectious complications occurred.