Although a well-known complication of dental treatment, cervicofacial subcutaneous emphysema is uncommon, especially with co-existing pneumomediastinum. This complication is usually attributed to high-speed air-driven handpieces or air-water syringes. Pneumomediastinum is usually self-limiting but potentially life threatening. We present two cases where both patients suffered from cervicofacial subcutaneous emphysema, one additionally having pneumomediastinum following routine restorative dentistry.

Viktorsson TV¹, Einarsdottir H², Benedikz E³, Torfason B⁴

¹Department of Surgery, ²Department of Diagnostic Radiology, ³Department of Emergency Room Medicine, ⁴Department of Cardiothoracic Surgery, Landspítali- The National University Hospital of  Iceland.

1-A

Computed tomography (CT) of head, axial view. Severe subcutaneous emphysema over left buccal area and posteriorly to hypopharynx.

1-B

CT of lower head and upper neck, axial view. Subcutaneous emphysema on both sides of face and neck, and air-accumulation in retropharyngeal space.

1-C

CT of lower neck, axial view. Air in soft tissues on the left side, surrounding the trachea and air in upper mediastinum.

1-D

CT of thorax, coronal view. Air bilateral to the trachea (short arrows) which reaches down to the inferior right heart margin (long arrow).

Table I. Differential diagnosis of sudden cervicofacial swelling, common signs and causal factors.