Cutaneous and Mediastinal Emphysema Following Dental Cleaning

A previously healthy 22-year-old woman came to our emergency department with swelling of the neck after airflow dental cleaning. During the cleaning, the patient had experienced acute stabbing pain in the right dorsal region of the floor of the mouth and then fainted. In addition to facial swelling, clinical examination revealed crepitation on swallowing and on palpation of the mouth floor. Computed tomography detected extensive mediastinal and prevertebral emphysema extending around the oropharynx and to the midfacial area (Figure). Clinical chemistry showed leukocytosis (leukocytes 11.1 billion/L, CRP <4 mg/L). Esophagogastroduodenoscopy and bronchoscopy found no abnormalities. A 3-day course of antibiotic treatment (ampicillin/sulbactam) was started to prevent mediastinitis. The patient was then free of symptoms with normal leukocyte levels and could be sent home. Mediastinal emphysema as described here is a rare, potentially serious event in which pressurized air containing bacteria penetrates the head and neck via the gingival margin and tissue spaces.

Figure

Soft-tissue emphysema

Dr. med. Gustav Buescher, I. Medizinische Klinik, Universitätsklinikum Hamburg Eppendorf, [e-mail]

PD Dr. med. Hans Klose, Zentrum für Onkologie, Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf

Dr. med. Dipl. biochem. Alexander Schultze, Zentrale Notaufnahme, Universitätsklinikum Hamburg-Eppendorf

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

Translated from the original German by David Roseveare.

Cite this as: Buescher G, Klose H, Schultze A: Cutaneous and mediastinal emphysema following dental cleaning. Dtsch Arztebl Int 2022; 119: 112.
DOI: 10.3238/arztebl.m2022.0016

Images: Department of Diagnostic and Interventional Radiology, University Hospital Hamburg Eppendorf; Prof. Gerhard Adams