Cervicofacial Emphysema Secondary to Facebow Injury: A Case Report

Aim: To report the clinical case of a child with facial and periorbital emphysema caused by an orthodontic device. Case report: An 11-year-old child presented to our clinic showing moderate swelling of the left facial area. Based on his dental history, physical findings, and instrument examinations, the diagnosis of cervicofacial emphysema was established, caused by disengagement of the facebow. One week later, all swelling and crepitus had disappeared without complications. Most patients who develop subcutaneous emphysema after a dental procedure have only moderate local swelling, which normally resolves spontaneously and without complications within a week. However, the spread of large amounts of air into the deeper spaces may cause life-threatening sequelae. Conclusions: Orthodontists should be aware that the use of extraoral traction applied via a facebow can cause soft tissue injures and emphysema of the cervicofacial region. It is important to avoid misdiagnosis and to appropriately inform patient and parents about this condition.

cervicofacial emphysema, extraoral traction, facebow injuries

1. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous emphysema: pathophysiology, diagnosis, and management. Arch Intern Med, 144: 1447–1453, 1984.

2. Rossiter JL, Hendrix RA. Iatrogenic subcutaneous cervicofacial and mediastinal emphysema. J Otolaryngol, 20: 315–319, 1991.

3. Turnbull A. A remarkable coincidence in dental surgery. Br Med J, 1: 1131, 1900.

4. Horowitz I, Hirshberg A, Freedman A. Pneumomediastinum and sub-cutaneous emphysema following surgical extraction of mandibular third molars: three case reports. Oral Surg Oral Med Oral Pathol, 63: 25–28, 1987.

5. Sivaloganathan K, Whear NM. Surgical emphysema during restorative dentistry. Br Dent J, 169: 93–94, 1990.

6. Monsour PA, Savage NW. Cervicofacial emphysema following dental procedures. Aust Dent J, 34: 403–406, 1989.

7. Davies JM, Campbell LA. Fatal air embolism during dental implant surgery: a report of three cases. Can J Anaesth, 37: 112–121, 1990.

8. Heyman SN, Babayof I. Emphysematous complications in dentistry, 1960-1993: an illustrative case and review of the literature. Quintes-sence Int, 26: 535–543, 1995.

9. Cardo VA Jr, Mooney JW, Stratigos GT. Iatrogenic dental air emphy-sema: Report of a case. J Am Dent Assoc, 85: 144–147, 1972.

10. Snyder MB, Rosenberg ES. Subcutaneous emphysema during peri-odontal surgery: report of a case. J Periodontol, 48: 790–791, 1977.

11. Salib RJ, Valentine P, Akhtar S. Surgical emphysema following dental treatment J Laryngol Otol, 113: 756–758, 1999.

12. Schovelton DS. Surgical emphysema as a complication of dental oper-ations. Br Dent J, 102: 125–129, 1957.

13. Yamada H, Kawaguchi K, Tamura K, Sonoyama T, Iida N, Seto K. Facial emphysema caused by cheek bite. Int J Oral Maxillofac Surg, 35: 88–89, 2006.

14. Mohan B, Singh KP. Bilateral subcutaneous emphysema of the orbits following nose blowing. J Laryngol Otol. 115: 319–320, 2001.

15. Mayorga F, Infante P, Hernandez JM, Garcia A. Angioneurotic edema caused by ACEI: a case report. Med Oral, 5: 124–127, 2000.

16. Ali A, Cunliffe DR, Watt-Smith SR. Surgical emphysema and pneumo-mediastinum complicating dental extraction. Br Dent J, 188: 589–590, 2000.

17. Snyder MB, Rosenberg ES. Subcutaneous emphysema during peri-odontal surgery: report of a case. J Periodontol, 48: 790–791, 1977.

18. Dobler AA, Nathenson AL, Cameron JD, Carpel ET, Janda AM, Peder-son JE. A case of orbital emphysema as an ocular emergency. Retina, 13: 166–168, 1993.

19. Buckley MJ, Turvey TA, Schummann SP, Grimson BS. Orbital emphy-sema causing vision loss after a dental extraction. J Am Dent Assoc, 120: 421–422, 424, 1990.

20. Samuels RHO. A review of orthodontic face-bow injures and safety equipment. Am J Orthod Dentofac Orthop, 110: 269–272,