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Patient-induced progressive facial subcutaneous emphysema masquerading as odontogenic abscess
  1. Victor Ken On Chang1,2 and
  2. Hao-Hsuan Tsai3
  1. 1Oral and Maxillofacial Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
  2. 2School of Medicine and Oral Health, Griffith University, Southport, Queensland, Australia
  3. 3Oral and Maxillofacial Surgery, Townsville Hospital and Health Service, Townsville, Queensland, Australia
  1. Correspondence to Dr Victor Ken On Chang; victor.chang{at}health.qld.gov.au

Abstract

Facial subcutaneous emphysema (SE) is an uncommon sequelae of dental procedures and often attributed to the use of high-speed air-driven handpieces during surgical extractions, forcing air through fascial spaces. Rarely have there been documented cases of patient-induced SE. In this case report, we present an 18-year-old woman who was referred to the emergency department with a 5-day history of progressive swelling and pain to her right cheek, following a prolonged, but simple extraction of tooth 18. While the dentist and emergency physicians were concerned about an infectious aetiology, history taking, clinical review and imaging corroborated the diagnosis of patient-induced SE secondary to habitual straw use. This report highlights the need for routine postextraction counselling of sinus precautions irrespective of extraction complexity. Additionally, emergency physicians should be aware of SE masquerading as other pathology, including odontogenic abscesses, allergic reactions, angioedema and gas-forming bacterial infections, such as necrotising fasciitis, to ensure appropriate treatment is provided to patients.

  • dentistry and oral medicine
  • oral and maxillofacial surgery
  • emergency medicine
  • gas/free gas

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Footnotes

  • Contributors VKOC reviewed and provided clinical care to the patient on the initial presentation. VKOC consented the patient prior to commencement of the write-up. VKOC completed the initial draft of the manuscript. HHT reviewed and provided editions to the manuscript. VKOC and HHT reviewed appropriate imaging to use to illustrate this case. VKOC and HHT reviewed the final manuscript for submission. VKOC gained final written consent from the patient for the final manuscript. VKOC provided revisions of the article after review from editors of the journal.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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