Periorbital oedema after dental extraction: a case study.

Answer 1 The patient developed facial subcutaneous emphysema as a result of her dental procedure. Subcutaneous emphysema refers to the collection of air beneath the subcutaneous tissue. It is more commonly seen in facial bone fractures, infection by gas-producing organisms, tracheostomies and anterior neck dissections.1 Subcutaneous emphysema is a known, but rare, complication of dental procedures, especially extraction of the third molar.2–4 This is caused by the use of air-driven surgical instruments such as high-speed surgical drills and compressed-air syringes. It has been proposed that the use of these tools can push compressed air into the space between tissues, especially if there is a break in the mucosa;1 this probably accounts for the unusual sensation experienced by the patient during the procedure. The earliest documentation of this complication dates back to 1900 when an infantry bugler developed facial swelling when blowing his bugle after having a tooth extracted.5