Subcutaneous emphysema during third molar surgery: a case report

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

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Antibiotic Prophylaxis on Third Molar Extraction: Systematic Review of Recent Data

Antibiotics ◽

10.3390/antibiotics8020053 ◽

2019 ◽

Vol 8 (2) ◽

pp. 53 ◽

Cited By ~ 23

Author(s):

Gabriele Cervino ◽

Marco Cicciù ◽

Antonio Biondi ◽

Salvatore Bocchieri ◽

Alan Scott Herford ◽

...

Keyword(s):

Systematic Review ◽

Oral Surgery ◽

Third Molar ◽

Health Conditions ◽

Drug Misuse ◽

Third Molar Surgery ◽

Inclusion Criteria ◽

Third Molar Extraction ◽

Wisdom Teeth ◽

High Predictability

The aim of this paper was to highlight the most widely antibiotic protocols applied to the dental field, especially in the surgical treatment of impacted wisdom teeth. Once these protocols were screened, all the possible advantages or disadvantages for each drug and each posology were recorded in this review. In recent years, the need to use these protocols has been debated in the literature. The data obtained by this review underlined how antibiotic protocols applied to oral surgery treatments only included surgeries performed on patients who did not present other systemic pathologies. The first literature review obtained 140 results, and then after the application of the inclusion criteria, 12 papers were selected. The results showed that the most commonly used protocol involved the use of penicillin and clavulanate, obtaining safe clinical and prophylactic results in the management of infections. This widely used protocol seems to guarantee high predictability and safety. The presented review highlights the current possibility of antibiotic resistance affecting patients due to drug misuse. Further clinical studies are required to state specific guidelines; however, oral surgeons involved in third molar surgery should evaluate the local and general health conditions of the patients before suggesting any drug measures for patients.

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Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum After Third Molar Extraction

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2015.07.030 ◽

2015 ◽

Vol 73 (12) ◽

pp. 2286.e1-2286.e3 ◽

Cited By ~ 2

Author(s):

Maxime Picard ◽

Nathalie Pham Dang ◽

Jean Michel Mondie ◽

Isabelle Barthelemy

Keyword(s):

Subcutaneous Emphysema ◽

Third Molar ◽

Third Molar Extraction ◽

Molar Extraction

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TOMOGRAFIA COMPUTADORIZADA: VANTAGENS SOBRE A RADIOGRAFIA PANORÂMICA NA AVALIAÇÃO DE TERCEIROS MOLARES INFERIORES INCLUSOS

DENS ◽

10.5380/rd.v15i2.9202 ◽

2007 ◽

Vol 15 (2) ◽

Author(s):

Carolina LAZAROTTO ◽

Grasielle KARPSTEIN ◽

Wilson Kenji SHIROMA

Keyword(s):

Oral Surgery ◽

Third Molar ◽

Oral Pathology ◽

Conventional Radiography ◽

Mandibular Canal ◽

Radiographic Evaluation ◽

Third Molar Surgery ◽

Oral Radiology ◽

Conventional Tomography ◽

Macroscopic Findings

Tomografia Computadorizada: vantagens sobre a Radiografia Panorâmica na avaliação de terceiros molares inferiores inclusos. A cirurgia dos terceiros molares inferiores retidos pode levar a alterações sensoriais importantes, devido a trauma no nervo alveolar inferior, o qual no seu trajeto, apresenta relação intra-óssea importante com as raízes dos molares. A relação entre os ápices do terceiro molar e o canal mandibular deve ser previamente identificada à intervenção cirúrgica. O presente trabalho tem por objetivo a comparação das imagens, da relação dos terceiros molares inferiores retidos com o canal mandibular, fornecidas por radiografias panorâmicas (RP) e por tomografias computadorizadas (TC). Metodologia: Comparação de radiografias panorâmicas e suas respectivas TC, levando em consideração a relação de proximidade dos ápices dentários com o canal mandibular. Resultados: Das RP avaliadas, todas apresentaram imagem de sobreposição do canal mandibular, e uma delas, também sugeriu trajeto interradicular do mesmo. Na TC comprovou-se tridimensionalmente relação de proximidade dos mesmos e em um caso, descartou-se a possibilidade de um trajeto interradicular do canal mandibular. Conclusão: Pelo material analisado, sugere-se que a TC mostra-se superior no diagnóstico e planejamento cirúrgico de terceiros molares inclusos. Palavras-Chave: Tomografia; Radiografia Panorâmica; Nervo Mandibular Referências Bibliográficas 1. DÍAZ-TORRES, M. J. et al. Fatores clínicos y radiológicos de “verdadera relación” entre el nervio dentário y el tercer molar. Revista Española de Cirurgia Oral y Maxillofacial, v. XII, n. 2, p. 51-57, 1990.2. FREDERIKSEN, N.L.; Diagnostic imaging in dental implantology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. v.80, 540-554, 1995.3. KINGLE, B.; PETERSSON, A.; MALY, P. Location of the mandibular canal: comparison of Macroscopic findings, conventional radiography, and computed tomography. Int J Oral Maxillofac Implants. v. 4, p. 327-332, 1989.4. LINDH, C.; PETERSON, A. Radiologic examination for location the mandibular canal: A comparision between panoramic radiography and conventional tomography. The International Journal of Oral & Maxillofacial Implants. V. 4, n. 3, p.249-253, 1989.5. SINN, D. P.; KARAS, N. D. Radiographic evaluation of facial injuries. In: FONSECA, R. J.; WALKER, R. V. Oral and Maxillofacial Trauma. 2. ed. Saunders Company, 1997. p. 391-418.6. GRAZIANI, Mario. Cirurgia bucomaxilofacial. 8. ed. Rio de Janeiro: Guanabara Koogan, c1995.7. GOMES, A. C. et al. Estudo das lesões nervosas após cirurgia dos terceiros molares inferiores retidos. Dissertação de Mestrado em odontologia – Faculdade de Odontologia de Pernambuco – Camaragibe-Pe, 2001. 123 p.8. FÉLEZ-GUTIÉRREZ, J. et al. Las lesiones Del nervio dentario inferior en el tratamiento quirúrgico del tercer molar inferior retenido: aspectos radiológicos, prognósticos y preventivos. Archivos de Odontoestomatología, v. 13, n. 2, p. 73-83, 1997.9. KINGLE, B.; PETERSSON, A.; MALY, P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computedtomography. Int J Oral Maxillofac Implants, v. 4, p. 327-332, 1989.10. RUD, J. Third molar surgery: relationship of root to mandibular canal and injuries to inferior dental nerve. Tandlaegebladet, v. 87, n. 18, p. 619-630, 1983.

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Oral surgery

Oxford Handbook of Clinical Dentistry ◽

10.1093/med/9780198832171.003.0010 ◽

2020 ◽

pp. 377-429

Keyword(s):

Soft Tissue ◽

Oral Surgery ◽

Third Molar ◽

Third Molar Surgery ◽

Dental Practice ◽

Comprehensive Overview ◽

General Dental Practice ◽

Dental Procedures ◽

Operative Assessment

This chapter provides a comprehensive overview of several aspects of oral surgery. It starts with some general principles that are applicable to all types of surgery and gradually includes details of common dental procedures. There is emphasis on suturing and dento-alveolar surgery including third molar surgery. More specialized procedures such as an apicectomy and a coronectomy are also described. The aim is to provide guidance that will help with the pre-operative assessment, as well as details of the specific oral surgery techniques. Clinicians in general dental practice and dental core trainees in hospitals often encounter patients with dento-alveolar infections as well as benign soft tissue or bone pathologies. This chapter provides the foundations of management of these conditions.

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Investigation of the Electric Handpiece-related Pneumomediastinum and Cervicofacial Subcutaneous Emphysema in Third Molar Surgery

Journal of Hard Tissue Biology ◽

10.2485/jhtb.28.79 ◽

2019 ◽

Vol 28 (1) ◽

pp. 79-86 ◽

Cited By ~ 1

Author(s):

Keiichi Ohta ◽

Hitoshi Yoshimura ◽

Takashi Ryoke ◽

Shinpei Matsuda ◽

Hisato Yoshida ◽

...

Keyword(s):

Subcutaneous Emphysema ◽

Third Molar ◽

Third Molar Surgery

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Dexmedetomidine Sedation With and Without Midazolam for Third Molar Surgery

Anesthesia Progress ◽

10.2344/0003-3006-61.1.3 ◽

2014 ◽

Vol 61 (1) ◽

pp. 3-10 ◽

Cited By ~ 14

Author(s):

Megann K. Smiley ◽

Simon R. Prior

Keyword(s):

Oral Surgery ◽

Third Molar ◽

The Other ◽

Third Molar Surgery ◽

Patient Anxiety ◽

Discharge Time ◽

Amnesic Effect ◽

Clinically Significant ◽

Prolonged Discharge ◽

Dexmedetomidine Infusion

Abstract Twenty-four patients were randomly divided into 2 groups. Intraoperatively, one group received a continuous intravenous infusion of dexmedetomidine alone, whereas the other received a continuous dexmedetomidine infusion plus a small dose of midazolam. Early measurements of patient anxiety and psychomotor performance were lower in patients who had received midazolam. This difference was not seen later in the appointment. An amnesic effect was observed in those patients who received midazolam. This effect, however, did not translate into increased patient satisfaction in the group receiving midazolam. Our findings suggest a prolonged discharge time for patients who had been given midazolam that may be clinically significant. Overall, dexmedetomidine showed an unpredictable sedative response and may be less practical than more common alternatives for oral surgery procedures.

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Randomized Split-Mouth Study on Postoperative Effects of Palmitoylethanolamide for Impacted Lower Third Molar Surgery

ISRN Surgery ◽

10.5402/2011/917350 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Christian Bacci ◽

Giulia Cassetta ◽

Bruno Emanuele ◽

Mario Berengo

Keyword(s):

Postoperative Pain ◽

Repeated Measures ◽

Third Molar ◽

Third Molar Surgery ◽

Third Molar Extraction ◽

Drug Tolerability ◽

Repeated Measures Analysis ◽

Surgical Extraction ◽

Over Time ◽

Molar Extraction

The aim of this study was to assess the efficacy of Normast 300 mg in reducing swelling and pain after the surgical extraction of impacted lower third molars. Materials and Methods. A randomized, split-mouth, single-blind study was conducted on 30 patients between 18 and 30 years of age requiring lower third molar extraction. Patients underwent bilateral extractions in a randomized sequence, one extraction being performed under Normast treatment. The Normast treatment involved 2 tablets a day for 15 days. The parameters assessed at each procedure were trismus, swelling, pain, NSAID consumption, postoperative complications, drug tolerability, and safety. The results obtained were processed using repeated measures analysis of variance. Results. Perceived postoperative pain was reportedly significantly milder on Normast treatment than control. The trend of the means differed over time (P<.0001) and between the two extraction groups (P<.0221). On the other hand, for edema and trismus, the trend differed over time for both groups but did not differ between the two groups. Discussion. Our analyses indicate that patients experienced significantly less postoperative pain when they were treated with Normast. Conclusions. Administering Normast improves the postoperative course—in terms of pain—after lower third molar extraction.

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Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study

PLoS ONE ◽

10.1371/journal.pone.0254221 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254221

Author(s):

Hiroki Otake ◽

Yoko Sato ◽

Eiji Nakatani ◽

Philip Hawke ◽

Shingo Takei ◽

...

Keyword(s):

Oral Surgery ◽

Third Molar ◽

Spontaneous Pain ◽

Extraction Socket ◽

Dry Socket ◽

Third Molar Extraction ◽

Loxoprofen Sodium ◽

Patient Reported ◽

60Mg Tablet ◽

Molar Extraction

Objectives Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. Methods This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). Results The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. Conclusions and clinical relevance Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

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