Severe breathing and swallowing difficulties during routine restorative dentistry

Abstract

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