Surgical Emphysema — ORE Part 1 MCQ

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ModerateOral SurgerySurgical EmphysemaORE Part 1

During use of a high-speed air turbine handpiece, a patient develops sudden unilateral facial and neck swelling with palpable crepitus. They are comfortable, with normal observations and no dyspnoea, dysphagia, voice change or chest pain. What is the most appropriate management?

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Correct answer: C — Observe closely, provide reassurance and prescribe antibiotic cover

This is uncomplicated dental procedure-related surgical emphysema: its immediate onset during air-turbine use and crepitus are characteristic. In a stable patient without airway, swallowing, voice or chest symptoms, management is conservative: stop the procedure, reassure, prescribe antibiotic cover, give analgesia if required and arrange close review with clear safety-netting. Resolution is usually spontaneous over several days. Emergency referral is required if there is dyspnoea, dysphagia, voice alteration, chest pain, extensive progression or suspected pneumomediastinum, but these features are absent. Surgical decompression and compression dressings are not routine treatment. Corticosteroids do not address the introduced air and are not standard sole therapy. Doing nothing is inappropriate because observation and advice are required, with antibiotic cover commonly recommended to reduce infection risk from oral flora.

Reference: Schuman NJ, Owens BM, Shelton JT. Subcutaneous emphysema after restorative dental treatment. Compendium of Continuing Education in Dentistry. 2001. https://pubmed.ncbi.nlm.nih.gov/11911057/