Severe breathing and swallowing difficulties during routine restoration desntistry

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COD: 2280_30_04_2015_ep Categorie: ,

Filippo Lococo, Laura Trabucco, Giovanni Leuzzi, Fulvio Salvo, Massimiliano Paci,Giorgio Sgarbi, Anna Maria Ferrari

Ann. Ital. Chir.Published online (EP) 30 April 2015

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Although sporadically reported after dental examination, subcutaneous emphysema may be erroneously confused with anallergic, or anaphylactic, reaction. We herein report a case of a 57-year-old Caucasian woman who came to our atten-tion after restorative treatment for a carious mandibular right second primary molar. During dental examination, anair driven hand-piece was used to restore occlusal caries. Suddenly, swallowing and breathing difficulties and a facialswelling involving the neck and, partially, the face occurred. She was urgently transported to the Emergency Departmentwith the suspicious of allergic reaction. Clinical examination revealed palpable crepitus at the level of the head, neckand pre-sternal region but no inflammation, trismus or fluid collection was detected. A Chest X-ray first and a com-puted tomography scan later showed air in the deeper regions from the peri-mandibular and retro-mandibular spaces tothe sub-maxillary and latero-cervical area along the vascular sulcus and retropharyngeal space descending into the medi-astinal space. So, the patient was admitted for respiratory monitoring and started intravenous administration of large-spectrum antibiotics and analgesics. Her hospital course was unremarkable and 5 days later she was discharged afterregression of symptoms and complete radiological resolution. Three months after discharge, the patient was clinically freeof recurrence.