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The causes of subcutaneous emphysema of relevance to dental practitioners?
Evidence-Based Dentistry Pub Date : 2019-12-01 , DOI: 10.1038/s41432-019-0065-y Emil S Pais 1
Evidence-Based Dentistry Pub Date : 2019-12-01 , DOI: 10.1038/s41432-019-0065-y Emil S Pais 1
Affiliation
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Data sources An electronic search was conducted using EMBASE, LILACS, PubMed, SciELO, Scopus, Web of Science, and two grey literature data sources. All issues of nine dentistry journals and relevant chapters in four endodontic textbooks were manually searched.Study selection Abstracts of all the studies that were identified during the electronic and manual searches were obtained and screened independently by two reviewers in order to select clinical studies, case series, or case reports describing subcutaneous emphysema that occurred in adult patients during or immediately after root canal treatment.Data extraction and synthesis Predetermined data were extracted from each study independently by two reviewers and organised into data tables. All disagreements were resolved through discussion with a third reviewer. The data obtained were combined through a narrative synthesis.Results Following full-text evaluation according to the inclusion criteria, 51 articles that described 65 cases of subcutaneous emphysema were included. There were 36 case reports and 15 case series. The condition was mainly reported in female patients and maxillary teeth. While the age of the patients ranged from 18 to 63 years, this demographic information was missing from a few studies. Details on the involved tooth and diagnosis were also missing from several articles. In most of the cases, subcutaneous emphysema developed during initial root canal treatment. The diagnosis was mainly based on intraoral, plain facial, neck, or chest radiographs, while computed tomography (CT) scans were obtained in fewer cases. The majority of the patients were referred to a different practice, a hospital or university clinic for the management of the condition by more specialised healthcare practitioners. In addition to drying root canals using air pressure, irrigation with hydrogen peroxide, and the air-water spray produced by handpieces, it was reported that laser-produced spray and ozone gas infiltration may also be the culprits of subcutaneous emphysema. The signs and symptoms resolve within 17 days. Its management mostly remains empirical and involves the use of antibiotics, analgesics, local application of cold or hot compresses, or administration of oxygen and hospitalisation, among other methods.Conclusions The systematic review showed that subcutaneous emphysema can occur during both surgical and nonsurgical endodontic treatment. Air streams or air-water sprays should not be directed toward the root canals or areas with mucosal discontinuity. None of the management approaches were clearly associated with a faster recovery. The review asked for developing guidelines in order to avoid unnecessary or potentially harmful interventions.
中文翻译：
与牙科医生相关的皮下气肿的原因？
数据源 使用 EMBASE、LILACS、PubMed、SciELO、Scopus、Web of Science 和两个灰色文献数据源进行电子搜索。手动检索了 9 种牙科期刊的所有问题和 4 种牙髓教科书中的相关章节。研究选择 在电子和手动检索过程中确定的所有研究的摘要由两名审稿人独立获得和筛选，以选择临床研究、病例系列，或描述成人患者在根管治疗期间或之后立即发生的皮下肺气肿的病例报告。数据提取和合成 由两名审查员独立从每项研究中提取预定数据，并组织成数据表。所有分歧均通过与第三位评审员讨论解决。所得数据通过叙述性合成进行合并。结果按照纳入标准进行全文评价，共纳入描述65例皮下气肿病例的51篇文章。共有36个病例报告和15个病例系列。该病主要见于女性患者和上颌牙齿。虽然患者的年龄从 18 岁到 63 岁不等，但一些研究缺少这种人口统计信息。几篇文章也缺少有关牙齿和诊断的详细信息。在大多数情况下，皮下气肿是在初始根管治疗期间发生的。诊断主要基于口内、面部、颈部或胸部 X 光片，而在少数病例中获得计算机断层扫描 (CT) 扫描。大多数患者被转诊到不同的诊所，由更专业的医疗保健从业者管理病情的医院或大学诊所。除了使用气压干燥根管、用过氧化氢冲洗和手机产生的空气-水喷雾外，据报道，激光产生的喷雾和臭氧气体渗透也可能是皮下气肿的罪魁祸首。体征和症状在 17 天内消退。其管理主要是经验性的，包括使用抗生素、镇痛剂、局部冷敷或热敷、吸氧和住院治疗等方法。 . 气流或空气-水喷雾不应直接朝向根管或黏膜不连续的区域。没有一种管理方法与更快的恢复明显相关。该审查要求制定指南以避免不必要或可能有害的干预措施。
更新日期：2019-12-20
中文翻译：
与牙科医生相关的皮下气肿的原因？
数据源 使用 EMBASE、LILACS、PubMed、SciELO、Scopus、Web of Science 和两个灰色文献数据源进行电子搜索。手动检索了 9 种牙科期刊的所有问题和 4 种牙髓教科书中的相关章节。研究选择 在电子和手动检索过程中确定的所有研究的摘要由两名审稿人独立获得和筛选，以选择临床研究、病例系列，或描述成人患者在根管治疗期间或之后立即发生的皮下肺气肿的病例报告。数据提取和合成 由两名审查员独立从每项研究中提取预定数据，并组织成数据表。所有分歧均通过与第三位评审员讨论解决。所得数据通过叙述性合成进行合并。结果按照纳入标准进行全文评价，共纳入描述65例皮下气肿病例的51篇文章。共有36个病例报告和15个病例系列。该病主要见于女性患者和上颌牙齿。虽然患者的年龄从 18 岁到 63 岁不等，但一些研究缺少这种人口统计信息。几篇文章也缺少有关牙齿和诊断的详细信息。在大多数情况下，皮下气肿是在初始根管治疗期间发生的。诊断主要基于口内、面部、颈部或胸部 X 光片，而在少数病例中获得计算机断层扫描 (CT) 扫描。大多数患者被转诊到不同的诊所，由更专业的医疗保健从业者管理病情的医院或大学诊所。除了使用气压干燥根管、用过氧化氢冲洗和手机产生的空气-水喷雾外，据报道，激光产生的喷雾和臭氧气体渗透也可能是皮下气肿的罪魁祸首。体征和症状在 17 天内消退。其管理主要是经验性的，包括使用抗生素、镇痛剂、局部冷敷或热敷、吸氧和住院治疗等方法。 . 气流或空气-水喷雾不应直接朝向根管或黏膜不连续的区域。没有一种管理方法与更快的恢复明显相关。该审查要求制定指南以避免不必要或可能有害的干预措施。
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