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原文題目(出處)： Periorbital oedema and surgical emphysema, an unusual complication of a dental procedure: a case report Cases Journal 2009;2:8108.
原文作者姓名： Parkar A, Medhurst C, Irbash M, Philpott C
通訊作者學校： Accident and Emergency Department, Colchester University Hospital NHS Foundation Trust, Colchester, UK
報告者姓名(組別)： R2 王俊欽 報告日期： 2009.12.11 內文：
Introduction
◎Surgical emphysema - Gas or air trapped in the subcutaneous tissue
- Common causes giving this condition – Tracheotomy(氣切)
Direct laryngoscopy(直接喉鏡檢查) Oesophagoscopy(食管鏡檢查)
◎Subcutaneous and mediastinal(縱膈) emphysema - have been previously reported after dental and oral surgical procedures, but remains a rare
◎There appears to be no evidence in the literature –
+ +
Case presentation
◎ A 55-year-old British Caucasian female
- Root canal treatment for left upper molar tooth under local anaesthetic - Swelling and discomfort around left eye
◎ Accident and Emergency department
- Diagnosed as allergic reaction to local anaesthetic, - Treated with antihistaminic and discharged
◎ Accident and Emergency department - Inability to open her left eye due to severe
- Periorbital oedema and surgical emphysema of left side of face and neck with a palpable crepitus Periorbital oedema
Emphysem Dental treatment.
An hour
Six hour
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◎ P’t:
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Not complain of respiratory distress, hoarseness, chest pain, dysphagia or odynophagia - Haemodynamically stable and apyrexia◎ Radiographs of chest, neck and face
- No evidence of pneumothorax but lateral neck radiograph showed air in the prevertebral tissue - Surgical emphysema of the neck which had no connection with the chest
◎ A stat dose of intravenous steroids and antihistamine
◎ She was started on prophylactic intravenous antibiotics and admitted for observation
◎ Showed signs of satisfactory recovery and partial opening of her eye
◎ She showed significant recovery with decreased periorbital oedema, surgical emphysema and was discharged home on oral antibiotics
Periorbital oedema and facial swelling on left side
Surgical Emphysema over the face and neck
Periorbital oedema
After 10 hours
Next day
口腔病理科 On-Line KMU Student Bulletin
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surgical emphysema
-★Traumatic facial injury,
★Rupture of pulmonary bulla,
★Prolonged surgical procedure,
★Direct injection of air during dental procedure- as in the case described in this report
◎ She recovered completely in about 10 days.
Discussion
◎Surgical emphysema is a known complication of root canal treatment
◎Periorbital oedema following a dental procedure is what makes this case report interesting
◎Turnball in 1900 –
★First reported case of subcutaneous emphysema following a dental procedure described facial emphysema after premolar extraction
◎Earlier, less patient friendly dental hand operated drills
◎More efficient rotary drills in 1870
◎Electric dental drill
◎High speed -
★Air turbine drills used in dental surgery today are similarly associated with this complication
★Forcefully injected into surrounding subcutaneous tissues in the facial planes
◎The roots of the first, second and third molars communicate directly with the sublingual and submandibular spaces.
◎After a dental procedure, the roots may give way to injected air and result in surgical emphysema
◎In this case
★ The oedema around the eye was not typical of surgical emphysema which has a characteristic palpable crepitus.
★The mechanism for this occurrence is not clear but may result in fluid being forced subcutaneously from the site of the dental treatment in the upper jaw
★The normal saline used during the procedure would most likely contain contaminants from the oral cavity, - - a risk of infection, which is why our patient was treated with antibiotics
About 10 days
Sublingual space
is also in direct communication with ★ Pterygomandibular space★ Para pharyngeal space
★ Retropharyngeal space
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Conclusion
◎ Unlike in other reported cases, our patient had none of the rarer, more serious or fatal complications of surgical emphysema following dental treatment such as
★ Temporary auditory disturbances,暫時聽覺障礙
★ Orbital emphysema,
★ Retinal artery collapse, 視網膜動脈損害
★ Optic nerve damage, 視神經受損
★ Tension pneumothorax or pneumoperitoneum 張力性氣胸 腹腔積氣
◎ It is not uncommon for patients to present to the Emergency department with dental problems for which accurate advice and specialist treatment may be lacking where local maxillofacial or dental surgical services are not immediately available
◎ These include post extraction bleeding and dental abscesses.
◎ This case highlights a rare but important complication of dental procedures that may attend the emergency department which can have serious consequences for the patient if not identified and treated promptly.
題號 - 題目
1
下列何者不是常見牙科治療後所引起 emphysema(氣腫)的原因(A)
After the use of compressed air by the clinician(B)
After difficult or prolonged extractions(C) (D)
As a result of increased intraoral pressure
(e.g.,sneezing,blowing) after an oral surgical procedure After Dexaltin application
答案(D) 出處：Oral and Maxillofacial PATHOLOGY P323
題號 題目
