5/16/2023 0 Comments Bubble trouble aj chest1 This can also be differentiated from other diagnoses as the swelling is soft on palpation and usually lacks the warmth and erythema noted in either hypersensitivity reactions, cellulitis, and hematomas. One can be almost certain that subcutaneous emphysema is present if crepitus or crackles are felt when palpating the swollen tissues. 9 Considering this list of differentials, the distinction of subcutaneous emphysema can usually be made by judicious palpation. 8 If swelling is delayed, this reaction may be mistaken for bacterial infections such as cellulitis or necrotizing fasciitis. Rapid swelling may result from a hypersensitivity reaction, anaphylaxis, angioedema, or a hematoma. 7 Unfortunately, many other complications of dental work may present with similar symptoms as subcutaneous emphysema. The first sign of subcutaneous emphysema may be readily evident as either immediate or delayed tissue swelling. Signs, symptoms, and differential diagnosis 5 Pressure in these anatomical spaces has been reported to cause respiratory arrest and cardiac dysrhythmias. 4 Air in these areas can quickly spread into the neck and retropharyngeal space, which communicates directly with the mediastinum and thoracic cavity. 4 This poses the greatest risk when the offending air source is located at a site near the mandibular molars, as air may be forced into the buccal, submandibular, and sublingual spaces. 1 In rare instances, air may accumulate and spread into facial spaces. Subcutaneous facial emphysema usually follows an indolent course. Therefore, it is prudent to understand the pathophysiology, management, and sequelae of subcutaneous emphysema to avoid dangerous complications. 1 It is evident that even with strict preventative measures, patients are still at risk of this complication. 3 The use of air-cooled lasers accounts for roughly 15% of reported subcutaneous facial emphysema cases in dentistry. Reports of subcutaneous emphysema have also followed the use of gingival retraction cords, as the pressure from cord packing may cleave gingival attachment. 2 Cavity preparation using air-driven handpieces or air-water syringes for buccal lesions may push air into these pathological periodontal tissue spaces. Patients with periodontal disease and minimally attached gingiva are at an increased risk of subcutaneous emphysema during routine restorative and endodontic procedures. Other dental causes of subcutaneous emphysema have been reported in literature. 1 Tooth sectioning and bone troughing, in combination with a raised mucosal flap, exposes a space between the periosteum and the bone where air may become entrapped. The most common iatrogenic cause of subcutaneous facial emphysema is the use of air-driven handpieces during tooth extraction. The oral cavity is a particularly susceptible location for the initiation of subcutaneous emphysema as a multitude of dental procedures involve soft tissue manipulation. Life-threatening complications can be avoided by diligent diagnosis and management. The consequences of subcutaneous emphysema may be profound. This trapping of air can progressively spread through the facial spaces, which are anatomical regions of loose connective tissue between muscles and bones. It arises when air is forcefully pushed into the submucosal spaces, leading to tissue distension. Subcutaneous emphysema is a well-known complication that can occur during dental procedures.
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