Severe Cervicofacial Emphysema and Pneumomediastinum Caused by a Dental Handpiece: A Case Report and Guidelines for Management for the Dental Practitioner.

Cervicofacial emphysema (CE) is a rare but potentially serious condition that can arise iatrogenically from dental or surgical procedures. Dental handpieces with fore-exhaust can inject air into tissues at pressures at or greater than 30 psi. Since 1963, there have been approximately 100 case reports in the literature of iatrogenic CE from routine dental procedures. Prompt recognition and treatment are essential; however, many general practitioners may only be familiar with CE from their dental school curriculum. A case of unusually severe cervicofacial emphysema with concomitant pneumomediastinum is presented, along with a discussion and review of management principles for the general dentist. It is our hope that refamiliarization with this condition will give the general dentist an appreciation for and recognition of signs of CE, thereby being the first. link in a chain of successful treatment.