Mediastinal and Cutaneous Emphysema Following Dental Extraction

Figure

Coronary computed tomography of head and neck. The arrow shows the opening at the level of extraction of molar 48

A 32-year-old man was referred to our general emergency department by his primary care physician for investigation of cutaneous emphysema. Clinical examination revealed characteristic crepitations on palpation of the skin above the clavicle and on the neck. On questioning, the patient mentioned no history of trauma, violent coughing, or vomiting. Thoracic radiography on expiration with the patient standing upright showed the cutaneous emphysema and also mediastinal emphysema. No pneumothorax could be discerned. Only later did the patient report the removal of all four wisdom teeth a few weeks previously. Since the extraction he had been cleaning out the wound cavities himself by means of irrigation. Computed tomography of the head and neck showed a fistula extending from the site of extraction of molar 48 with a clear air conduit into the soft tissue. As soon as the patient desisted from oral irrigation the cutaneous emphysema regressed and the fistula healed spontaneously. The patient’s C-reactive protein (CRP) level was elevated (75 mg/L) and he was given antibiotics. His condition improved progressively and he was discharged a few days later.

Christof Fehrle, Zentrale Notaufnahme, Klinikum am Steinenberg Reutlingen, [e-mail]

Prof. Dr. med. Adrian Gillissen M.Sc., Medizinische Klinik III, Kreiskliniken Reutlingen/Ermstalklinik Reutlingen - Bad Urach

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare

Cite this as: Fehrle C, Gillissen A: Mediastinal and cutaneous emphysema following dental extraction. Dtsch Arztebl Int 2019; 116: 212. DOI: 10.3238/arztebl.2019.0212a