Between October 6,1986 and September 17,1987, 11 patients underwent insertion of mandibular dental prostheses by the same oral surgeon. Three patients suffered cardiac arrest during surgery and subsequently died. Two of the patients who died had received general anaesthetics and the other had intravenous sedation given by three different anaesthetists. All three patients arrested suddenly, developing profound cyanosis and electrical mechanical dissociation, underwent prolonged resuscitative efforts, and had marked hypoxaemia and hypercapnia, despite cardiopulmonary resuscitation. Two other patients had signs of injection of air but survived, one suffering cardiac collapse and the other sustaining massive subcutaneous emphysema. Air embolism was produced by inadvertent injection of a mixture of air and water, passing through the hollow dental drill, directly into the mandible to the facial and pterygoidplexus veins and thence to the superior vena cava and right atrium.  To find out … Read more

Subcutaneous emphysema, surgical emphysema, or tissue space emphysema are different names for a similar condition, namely, the abnormal presence of air in tissue spaces Subcutaneous emphysema occurs rarely during dental procedures. When it does occur, it can be a frightening experience that often will be confused with an anaphylactic reaction. Differentiating the two conditions is not difficult. Palpation of the swollen head and neck areas will elicit crepitus, or a ‘Velcro’ sensation, that is not present in anaphylaxis. Anaphylaxis occurs after exposure to an allergen that elicits an IgE-mediated hypersensitivity that leads to an abrupt onset of symptoms that may include pruritis of lips, tongue and palate; oedema of the lips; nausea; vomiting; dysponea; wheezing; rhinorrhoea; syncope and hypotension. Anaphylaxis is a true medical emergency, whereas subcutaneous emphysema is generally not life-threatening. Therapy for subcutaneous emphysema involves the following: (i) … Read more