A case of subcutaneous emphysema caused by nose blowing after lower third molars extractions

DOI
  • TSUBOI Kanako
    Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University Department of Oral and Maxillofacial Surgery, Haibara General Hospital
  • SATOH Akira
    Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University
  • KITAGAWA Yoshimasa
    Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University

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Other Title
  • 下顎智歯抜歯後の擤鼻により生じた皮下気腫の1例

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A 37-year-old man underwent extraction of bilateral impacted lower third molars under general anesthesia. Two hours after the operation, his right cheek suddenly became swollen after nose-blowing. We recognized rapid swelling from the right cheek to the angle of the mandible and submandibular area and crepitus on palpation over the submandibular area. We diagnosed it as subcutaneous emphysema and administered an intravenous antibiotic. CT analysis on the next day revealed subcutaneous emphysema bilaterally, and the right side one in particular extended to the mediastinum. The air compressed by nose-blowing might have entered the subcutaneous tissue via a bone defect in the extraction socket. After one week, the emphysema had nearly disappeared. We confirmed the complete disappearance after 3 weeks on CT. The main cause of emphysema after extraction of the mandibular third molars is the use of an air-turbine handpiece. However, even when not using an air-turbine handpiece, we should perform treatment with care to avoid emphysema.

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