Subcutaneous Emphysema after Root Canal Therapy

The introduction of air into subcutaneous tissues - known as emphysema, abbreviated SE- during dental procedures can be harmful. The most prominent clinical feature of SE is a rapid swelling of the face and sometimes the neck. Pain is variable and usually of short duration. On rare occasions, stabbing precordial chest pain, the most common complaint of patients with pneumomediastinum is associated with stretching of interstitial soft tissues caused by dissection of air. Patient hospitalization is required in such a case. While opening the access cavity for endodontic treatment, SE can be caused by the use of an air-driven high speed handpiece and compressed air-syringe. The dentist should use caution to avoid the use of compressed air to dry a canal which can be very risky for introducing air into tissues. Additional preventive measures are the use of a well fitted rubber dam, using high speed aspiration or paper points to dry fluids from the root canal, among others. Early recognition of the clinical presentation of SE is of extreme importance to prevent possible secondary infections and cardiopulmonary complications.