SUBCUTANEOUS EMPHYSEMA DURING ENDODONTIC TREATMENT: CAUSES, RISK FACTORS AND MANAGEMENT APPROACHES
DOI:
https://doi.org/10.35220/2523-420X/2025.3.12Keywords:
subcutaneous emphysema, endodontic treatment, complicationsAbstract
Purpose of the study. To systematize data on the main causes and mechanisms of subcutaneous emphysema development during or after dental procedures in general and endodontic manipulations particularly; to assess the significance of various risk factors associated with the development of subcutaneous emphysema during root canal treatment and the subsequent migration of infiltrated air volume into different interstitial spaces; to analyze management approaches for cases of subcutaneous emphysema during dental treatment and to outline the conditions that justify the need for patient hospitalization in the event of the occurrence and/or progression of this type of complication.Research methods. The main research methods used were a retrospective review of literature data and a content-analysis of selected publications related to the causes, risk factors, and approaches to the treatment/ management of cases with reported signs of subcutaneous emphysema during or after dental procedures in general and endodontic interventions in particular. To maximize the initial sample of scientific publications relevant to the aim of the study, the search was performed through the Google Scholar system using the advanced search options.Additional analysis of the initially selected scientific works was also carried out using the search capabilities of the Connected Papers service.Scientific novelty. The symptoms of subcutaneous emphysema that may develop during root canal treatment are typical and characteristic of other types of facial emphysema as well. They include crepitus on palpation, progressive swelling without significant changes in the color of the soft tissues, and tenderness/pain depending on the degree of tissue overstretching caused by the volume of air. According to previous laboratory studies, an apical foramen size equivalent to ISO size 25 or greater during root canal treatment increases the risk of emphysema development during prolonged exposure to air flow of certain speed and pressure. Management of cases of emphysema that develop during or after root canal treatment is mostly empirical and depends on the severity of the symptoms. The prescription of antibiotics is justified by the need to prevent infectious complications.Hospitalization of a patient with signs of air emphysema is indicated in cases of significant swelling in the head and neck area, migration of air volume with the development of dyspnea or dysphagia, or in cases of emphysema in patients with compromised general health status.Conclusions. The data aggregated and analyzed in this literature review showed that the proportion of cases of subcutaneous emphysema occurring specifically during endodontic interventions among all reported cases of emphysema arising during or after dental treatment is low and does not exceed 10%. At the same time, cases of subcutaneous emphysema that occur specifically during endodontic procedures are characterized by certain features that distinguish them from the general characteristics of emphysema development during other dental treatments: most cases are observed during the treatment of maxillary teeth, mainly during attempts to dry root canals with an air syringe or when using irrigants with oxygen-releasing effects, and the development of this type of complication requires the involvement of additional contributing factors (root wall integrity loss due to perforation or resorption, immature root formation condition, presence of a periapical lesion, or over-enlargement of the apical foramen area).
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