Tissue-space emphysema, tissue necrosis, and infection following use of compressed air during pulp therapy: case report.

The intraoperative development of tissue-space emphysema in a child undergoing restorative treatment under general anesthesia is presented. Emphysema development seems to be concomitant with the use of compressed air around patent root canals, complicated by tissue destruction due to movement of canal irrigants/medicaments into the periapical tissues and by secondary infection. Several recommendations for the prevention of tissue-space emphysema are presented including the use of a rubber dam, judicious use of compressed air, and maintenance of canal irrigants and medicaments within the root canal. Treatment recommendations vary from palliative care with follow up in cases of facial emphysema to immediate medical attention in cases of pharyngeal or mediastinal emphysema.