A 52-year-old woman was treated at the Dental Care Clinic of the Universidad de la Frontera for a class V restoration in the left lower first premolar, because it presented abrasion accompanied by great sensitivity.
The patient's medical history was normal, except for one urinary infection which was being treated with ciprofloxacin at the usual dose.
It is important to mention that the tooth presented a 4 mm periodontal pocket.
Troncular anesthesia was administered to the inferior dental nerve about an hour after the incident. The procedure began with placement of a hystostatic solution because the restoration was subgingival.
Cavitary preparation was performed with a high-speed handpiece.
Once the preparation was completed, it was filled with ionomer glass.
During the polishing performed with high speed handpiece and the use of a triple syringe, the operator observed the exit of air bubbles from the gingival groove and a strange increase in volume from which it pressed.
Faced with this situation an exhaustive intra and extraoral examination was carried out, finding swelling that affected the left mandibular region to the neck.
Lipid binding was not observed to increase temperature or tissue stiffness, but crepitation.
The patient had no pain but only mild discomfort and had no difficulty swallowing or respiratory disorders.
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Immediately, the patient was referred to the emergency service of the Dr. Hern Henríquez Arena Hospital, being re-examined there, and performing rigorous examinations.
Head and neck radiographs were taken, which confirmed the presence of air in subcutaneous tissues.
The diagnosis of subcutaneous emphysema was made from the findings and the entrance way was assumed the gingival sulcus.
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He was instructed to continue the antibiotic regimen with ciprofloxacin that he was already taking, and additionally analgesic therapy based on N-acetylcysteine 550 mg tablet every 12 hours for three days.
The next day, the persistence of crepitation and volume increase could be observed, without clinical evidence of infection.
It was suggested to continue with the antibiotic treatment and was cited for control in five days.
After this time a complete resolution of the volume increase was observed, there was no evidence of crepitation in the affected tissues and the patient was asymptomatic.
