上顎洞開窓手術既往のある患者にみられた皮下気腫と内出血を伴った症例

抄録

Abstract : In dental procedure, emphysema sometimes occurs by careless using of air turbine or air syringe. Especially, when hydrogen peroxide (H₂O₂) is used for root canal irrigation with syringe at root canal treatment, much oxygen generate rapidly from the interaction with catalase in case of bleeding. In this case report, pulpectomy of upper right canine was done on the patient who had history of the right maxillary sinusectomy about 38 years ago. 15% EDTA, 1% NaClO and 3% H₂O₂ were used for root canal irrigation after pulpectomy. But, bleeding in root canal did not stop after using those irrigants. Then, physiosaline solution was used as a irrigant to stop bleeding. Apical foramen was not destroyed by instrumentation, and gave apical stop with #25 k-file. However, patient complained feeling of swelling on the right face after these procedures. Emphysema with internal hemorrhage was observed on the right face and the oral mucous membrane. Antibiotics, anti-inflammatory drug and hemostatics were prescribed to patient. After two days, emphysema with internal hemorrhage has been spreading from the right to left face. This symptom disappeared after 30 days. It was thouht that bone of canine fossa and peri-apical bone of canine were destroyed due to the operation. It is reported that emphysema disappears usually in a week. However, it took 30 days for healing up. We have to be very careful at root canal irrigation like the present case for prevention of emphysema.