Mediastinal and subcutaneous emphysema following dental extraction and use of high speed air turbine drill

Mediastinal emphysema is a serious clinical entity. The number of reported cases related to dental extraction has recently increased due to the extensive use of modern high speed air drills, revolving at about 500,000 r/m and projecting water and air at 3.5-4.2 kg/cc. The condition occurs when there is sufficient pressure to force air from the floor of the mouth through the cervical planes into the mediastinum, and the water jet impedes the back flow of air. A case of a young patient with sudden appearance of subcutaneous and mediastinal emphysema following dental extraction with use of an air turbine handpiece is presented. The clinical and radiological findings disappeared after 96 hr. Special attention should be paid by dental ENT surgeons and general practitioners to this iatrogenic disease, because of its possible severe and sometimes fatal consequences.