Emphysema subcutaneous T79.7

Penetration of air into the subcutis, for example after injuries to the trachea and large bronchi. There are individual case reports of emphysema of the facial soft tissues after dental treatment (Radtke MA, Augustin M 2007).

Very rare!

Crackling, subcutaneous air cushion over the affected area. Usually extensive, painless, soft, skin-coloured or even slightly reddened, creeping swelling of the affected soft tissues of the head, neck, thorax and abdomen. The genitals can also be affected.

The disease can be classified according to 5 degrees of severity:

Grade 1: Base of neck

Grade 2: Entire neck

Grade 3: Subpectoralis major region

Grade 4:Thoracic wall and neck

Grade 5: Thoracic wall, neck, orbit, slave, abdominal wall, arms, scrotum

Xeroradiography, sonography, 20 MHz sonography.

Depending on the localization, regional infections (e.g. erysipelas of the genitals) or angioedema.

Hospitalization and immediate surgical attention. In case of organ perforation, pressure relief of the mediastinal emphysema by drainage; subcutaneous catherisation for ventilation is also possible.

Systemic antibiotic treatment with broad-spectrum antibiotics, e.g. ceftriaxone (e.g. Rocephin) once/day 2 g i.v.

A 55-year-old female patient sought dermatological advice because of a severe doughy swelling of the left half of her face which had been present for 12 hours. 1 day before, an extraction of a long term suppurated molar tooth had been performed. The diagnosis was made after skin sonography. After treatment with ceftriaxone once/day 2 g i.v. for 14 days the findings were healed.

1. Radtke MA, Augustin M (2007) Unilateral cervicofacial emphysema after dental treatment. skin type 58: 529-531
2. Schneider LA et al (2005) A swollen face after dental surgery. J Dtsch Dermatol Ges 3: 987-989
3. Vargo RJ et al (2016) Cervicofacial subcutaneous emphysema: a clinical case and review of theliterature
   . Gene Dent 64:68-71.