Academic Journal
Beyond benign swelling: fascial plane spread of dental therapy-related subcutaneous emphysema to critical cranio-cervicothoracic compartments - Clinical predictors and a management algorithm.
| Τίτλος: | Beyond benign swelling: fascial plane spread of dental therapy-related subcutaneous emphysema to critical cranio-cervicothoracic compartments - Clinical predictors and a management algorithm. |
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| Συγγραφείς: | Kalaitsidou I; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: ikalaitsidou@gmail.com., Schedeit C; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Tatsis D; Department of Oral and Maxillofacial Surgery, General Hospital of Thessaloniki 'G. Papanikolaou, Thessaloniki, Greece., Toneatti D; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Antoniou A; Department of Oral and Maxillofacial Surgery, General Hospital of Thessaloniki 'G. Papanikolaou, Thessaloniki, Greece., Wiegner S; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Karrer T; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Schaller B; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. |
| Πηγή: | Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery [J Craniomaxillofac Surg] 2026 Nov; Vol. 54 (11), pp. 109868. Date of Electronic Publication: 2026 Aug 16. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Scotland NLM ID: 8704309 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-4119 (Electronic) Linking ISSN: 10105182 NLM ISO Abbreviation: J Craniomaxillofac Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: Edinburgh : Elsevier Original Publication: Stuttgart ; New York : Thieme, [c1986- |
| Ιατρικοί όροι (MeSH): | Subcutaneous Emphysema*/etiology , Subcutaneous Emphysema*/therapy , Subcutaneous Emphysema*/diagnostic imaging , Dental Care*/adverse effects , Algorithms*, Mediastinal Emphysema/etiology ; Mediastinal Emphysema/diagnostic imaging ; Dental High-Speed Equipment/adverse effects ; Humans ; Retrospective Studies ; Female ; Male ; Iatrogenic Disease ; Middle Aged ; Tomography, X-Ray Computed ; Aged ; Adult |
| Περίληψη: | Iatrogenic subcutaneous emphysema (SE) is an uncommon but potentially life-threatening dental complication that can rapidly progress into deep cranio-cervicothoracic compartments. This retrospective cohort study systematically evaluated 74 consecutive patients treated at a tertiary referral center over an 11-year period to identify clinical predictors of deep fascial spread and develop a management algorithm. All patients underwent computed tomography (CT) to delineate the volumetric extent of air. Critical compartment involvement (CCI), including deep cervical, orbital, or mediastinal extension, was identified in 48.6% of cases. Multivariate logistic regression identified high-speed air-driven handpieces (OR 4.5, p = 0.002) and procedures involving posterior mandibular teeth (OR 2.8, p = 0.031) as independent predictors of CCI. Clinically, dysphagia served as a significant indicator of deeper fascial extension. While management was predominantly conservative with a mean hospital stay of 2.2 days, pneumomediastinum was confirmed in 16.2% of patients. Systematic CT imaging proved essential for detecting subclinical spread. These findings informed a practical risk-stratified management algorithm designed to enhance patient safety by providing clinicians with a structured framework for early risk recognition and optimized diagnostic and therapeutic pathways. (Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Competing Interests: | Conflicts of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Computed tomography; Dental procedures; High-speed dental equipment; Iatrogenic disease; Pneumomediastinum; Subcutaneous emphysema; X-ray |
| Entry Date(s): | Date Created: 20260816 Date Completed: 20261016 Latest Revision: 20261016 |
| Update Code: | 20261017 |
| DOI: | 10.1016/j.jcms.2026.109868 |
| PMID: | 42604631 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1878-4119 |
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| DOI: | 10.1016/j.jcms.2026.109868 |