2019 Volume 58 Issue 2 Pages 73-78
In this study, we investigated the clinical and imaging findings of 14 patients with subcutaneous emphysema, who were examined at our department between 2012 and 2017. Patients with subcutaneous redness, swelling, and crepitation that were suspected to be associated with subcutaneous emphysema were examined using computed tomography （CT）. The age, sex, affected region, administered treatment, time to the examination after onset, and whether the emphysema had spread into various tissue spaces were analyzed in these patients. The tissue spaces that were examined for subcutaneous emphysema were chosen based on the anatomical tissue space definitions produced by H. Ric Harnsberger16, and included the temporal, buccal, masticatory muscle, submandibular, parapharyngeal, posterior pharyngeal, parotid gland, submental, anterior and posterior cervical, and mediastinal spaces. These tissue spaces were examined for foamy structures and honeycomb or irregularly shaped regions of aeration, exhibiting homogeneously low signal intensity, which were considered to be indicative of the spread of subcutaneous emphysema. Clinical images are presented. Case 1 involved a patient with a maxillary alveolar fracture. Subcutaneous emphysema caused by a CO2 dental laser was noted in case 2. Regarding sex and age, the incidence of subcutaneous emphysema was significantly higher among females and patients in their 20s, and the most common site of occurrence was the lower jaw, especially the molar region. The most frequent cause was an air turbine used for tooth extraction. Regarding spread to tissue spaces, foamy structures and irregular regions of aeration with low signal intensity were noted in the masticatory muscle, submandibular, and parapharyngeal tissue spaces in 12 of the 14 patients. When a lower impacted wisdom tooth is extracted using an air turbine, compressed air-based dental treatment devices should be used very carefully, and when subcutaneous emphysema is suspected based on clinical findings it is necessary to immediately examine it using CT and determine its extent. It was suggested that CT is useful for diagnosing subcutaneous emphysema.
