Journal of Dental Rehabilitation and Applied Science (구강회복응용과학지)

Korean Academy of Stomatognathic Function and Occlusion (대한턱관절교합학회)
권호 표지
DOI QR코드

DOI QR Code

Syncope and pneumomediastinum during the maxillary sinus elevation with an air-syringe: a case report

주사기를 이용한 상악동 거상술 시 발생한 실신 및 종격동기종에 관한 증례보고

  • Kim, Su Wan (Department of Thoracic and Cardiovascular Surgery, Jeju National Hospital, Jeju National School of Medicine) ;
  • Lee, Jonggeun (Department of Thoracic and Cardiovascular Surgery, Jeju National Hospital, Jeju National School of Medicine) ;
  • Song, Ji-Young (Department of Dentistry, Jeju National Hospital, Jeju National School of Medicine)
  • 김수완 (제주대학교 의과대학 흉부외과학교실) ;
  • 이종근 (제주대학교 의과대학 흉부외과학교실) ;
  • 송지영 (제주대학교 의과대학 치과학교실)
  • Received : 2021.07.12
  • Accepted : 2021.08.31
  • Published : 2021.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Pneumomediastinum is a very rare and potentially catastrophic complication of dental procedures. Its common causes are tooth extraction, endodontic treatment, and subgingival curettage using handpieces and high-pressure air/water syringes. We present a case of massive pneumomediastinum with subcutaneous emphysema in a 61-year-old female who underwent bone grafting into the maxilla for pretreatment of dental implantation using a syringe. The patient suffered from abrupt severe odynophagia and loss of consciousness. The patient transferred to emergency department and images work-up revealed a pneumomediastinum and subcutaneous emphysema on the entire face and neck. We performed conservative treatments including prophylactic antibiotics, oxygen inhalation, and fasting meals, and then discharge after 7 days uneventfully. The patient's syncope might be resulting from hypotension and pain shock induced by pneumomediastinum with a sudden chest compression. The pneumomediastinum could be resulting from concurrent perforation and massive air infiltration into the maxillary sinus during bone grafting. We suggest that pneumomediastinum needs prompt diagnosis and management because of the risk of airway obstruction when a patient present syncope in the dental room.

종격동기종은 치과 영역에서 매우 드물고 잠재적으로 위험한 합병증이다. 이의 흔한 원인으로는 핸드피스와 고압 공기/물 주사기를 사용하는 발치, 근관치료, 잇몸 밑 치은연하 소파술 등이 있다. 본 증례는 임플란트 식립을 위한 전 치료로 주사기를 이용하여 상악동에 골이식을 시행받은 61세 여자에게서 발생한 대량의 종격동기종과 피하기종의 증례이다. 환자는 치료 도중 갑작스럽게 발생한 구강 통증과 함께 의식 소실이 발생하였고, 응급실로 전원 되었다. 영상학적 검사상 종격동기종과 함께 얼굴과 목부위 전체에 피하기종이 발견되었다. 예방적 항생제, 산소 흡입, 금식 등의 보존적 치료가 이루어졌고, 합병증 없이 7일 만에 퇴원하였다. 환자의 실신은 시술 중 상악동 천공 후 과량의 공기유입으로 인해 발생한 종격동기종에 의해 순간적인 강한 흉부 압박으로 혈압 감소와 통증 쇽에 의한 것으로 생각된다. 치과 치료 중 환자가 의식을 잃었다면 기도 폐쇄의 위험성이 있기 때문에 종격동기종을 즉각적으로 감별하고 치료해야 한다.

Keywords

Acknowledgement

이 논문은 2021학년도 제주대학교 교육·연구 및 학생 지도비 지원에 의해서 연구되었음.

References

  1. Rawlinson RD, Negmadjanov U, Rubay D, Ohanisian L, Waxman J. Pneumomediastinum After Dental Filling: A Rare Case Presentation. Cureus 2019;11:e5593.
  2. Reed KL. Basic management of medical emergencies: recognizing a patient's distress. J Am Dent Assoc 2010;141 Suppl 1:20S-4S. https://doi.org/10.14219/jada.archive.2010.0349
  3. Grapatsas K, Tsilogianni Z, Leivaditis V, Kotoulas S, Kotoulas C, Koletsis E, Iliadis IS, Dahm M, Trakada G, Veletza L, Kallianos A, Huang H, Kosmidis C, Karanikas M, Thomaidis V, Porpodis K, Zarogoulidis P. Hamman's syndrome (spontaneous pneumomediastinum presenting as subcutaneous emphysema): A rare case of the emergency department and review of the literature. Respir Med Case Rep 2017;23:63-5. https://doi.org/10.1016/j.rmcr.2017.12.004
  4. Rose WD, Veach JS, Tehranzdeh J. Spontaneous pneumomediastinum as a cause of neck pain, dysphagia, and chest pain. Arch Intern Med 1984;144:392-3. https://doi.org/10.1001/archinte.1984.00350140222030
  5. Starch-Jensen T, Jensen JD. Maxillary Sinus Floor Augmentation: a Review of Selected Treatment Modalities. J Oral Maxillofac Res 2017;8:e3. https://doi.org/10.5037/jomr.2017.8403
  6. Muronoi M, Xu H, Shimizu Y, Ooya K. Simplified procedure for augmentation of the sinus floor using a haemostatic nasal balloon. Br J Oral Maxillofac Surg 2003;41:120-1. https://doi.org/10.1016/S0266-4356(03)00040-8
  7. Kfir E, Kfir V, Mijiritsky E, Rafaeloff R, Kaluski E. Minimally invasive antral membrane balloon elevation followed by maxillary bone augmentation and implant fixation. J Oral Implantol 2006;32:26-33. https://doi.org/10.1563/782.1
  8. Hussein LA, Hassan TAL. The Effectiveness of Oxidized Regenerated Cellulose as a Graft Material in Transalveolar Osteotome Sinus Lift Procedure. J Craniofac Surg 2017;28:1766-71. https://doi.org/10.1097/SCS.0000000000003943
  9. Abolnik I, Lossos IS, Breuer R. Spontaneous pneumomediastinum. A report of 25 cases. Chest 1991;100:93-5. https://doi.org/10.1378/chest.100.1.93
  10. Goh BK, Yeo AW. Traumatic pneumorrhachis. J Trauma 2005;58:875-9. https://doi.org/10.1097/01.TA.0000158249.77176.9A
  11. Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE Jr. Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg 2008;86:962-6. https://doi.org/10.1016/j.athoracsur.2008.04.067
  12. Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci 2013;5:460-4. https://doi.org/10.4103/1947-2714.117296
  13. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med 1984;144:1447-53. https://doi.org/10.1001/archinte.1984.00350190143024
  14. Feldtman RW, Oram-Smith JC, Manning LG, Buckley CJ. Spontaneous mediastinal emphysema. J Pediatr Surg 1980;15:648-50. https://doi.org/10.1016/S0022-3468(80)80517-3