Article Text

Download PDFPDF
Subcutaneous facial emphysema secondary to a dental procedure
  1. Sara Isabel Almeida1,
  2. Joana Faustino2,
  3. Rui Duarte Armindo3 and
  4. Vanessa Mendonça1
  1. 1Paediatrics, Hospital Beatriz Ângelo, Loures, Lisboa, Portugal
  2. 2Paediatrics, Hospital Dona Estefânia, Lisboa, Portugal
  3. 3Department of Neuroradiology, Beatriz Angelo Hospital, Loures, Lisboa, Portugal
  1. Correspondence to Dr Joana Faustino; joanamotafaustino{at}


Subcutaneous emphysema is a possible but infrequent consequence of dental procedures. We present the case of a 6-year-old healthy boy transferred from a dental clinic immediately after local anaesthesia for tooth extraction, due to sudden orbital and facial swelling. On physical examination, oedema of the left upper eyelid with fine crepitus on palpation and left hemiface oedema with local pain were observed. Ophthalmologic observation was normal. CT scan of the face and orbits documented extensive infiltration of the subcutaneous tissue planes of the left face by air, with extension to the external part of the body of the mandible, retromaxillary fat, masticatory muscle spaces, parapharyngeal space and adjacent to the orbital roof. After completing initial evaluation, the dentist confirmed the use of an air-driven device during local anaesthesia administration. The patient improved with conservative treatment. Early recognition of this condition is essential to provide an adequate clinical assessment with exclusion of possible life-threatening complications.

  • air leaks
  • anaesthesia
  • dentistry and oral medicine
  • emergency medicine
  • empyema

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors The responsibility of bibliographical search and drafting of the article was given to SA and JF. The responsibility of selecting the images and critical reviewing of the content of the article was given to RDA and VM.

  • 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.