Dear Editor,A 35-year-old pregnant woman experienced right inferior molar pain and underwent dental treatment (including drill and laser treatment) under local anesthesia using lidocaine at 30 weeks of gestation. After this treatment, she felt face and neck swelling with dyspnea. She was transferred to our department by ambulance due to the suspicion of an anaphylactic reaction. Her medical and family histories were unremarkable. On arrival, her Glasgow Coma Scale score was 15. She had a blood pressure of 108/68 mmHg, heart rate of 67 beats/min, respiratory rate of 20 breaths/min, and SpO2 of 100% with oxygen (3 L/min). Subcutaneous crepitus was observed under the skin along the anterior chest wall and neck without skin lesions. The fetal heart rate was 110–160 beats/min and she was experiencing frequent uterine contractions. Computed tomography revealed subcutaneous emphysema and pneumomediastinum from the neck to the mediastinum [Figure 1]. She was admitted in hospital and an infusion of cefazolin and ritodrine was administered to prevent descending mediastinitis and abortion. Her symptoms subsided within a few days and she was discharged on the 4th day of hospitalization.
Figure 1
Computed tomography on arrival computed tomography demonstrates subcutaneous emphysema and pneumomediastinum from the neck to the mediastinum
Computed tomography on arrival computed tomography demonstrates subcutaneous emphysema and pneumomediastinum from the neck to the mediastinumSubcutaneous and mediastinal emphysema are rare complications that can occur after routine tooth treatment due to the use of a high-speed air turbine that runs on compressed air for dental drilling or dental lasers that utilize compressed air.[1] Pneumomediastinum as a spontaneous or medical disease is an extremely rare complication among pregnant women. This is the first reported case of a pregnant woman developing pneumomediastinum after a dental procedure.[234] Most cases of pneumomediastinum improve following medical treatment; however, this can be complicated by fatal descending necrotizing mediastinitis. As a normal pregnancy relies on a careful balance between immune tolerance and suppression, any imbalance between the proinflammatory and anti-inflammatory cytokines, and chemokines can lead to aberrant inflammation, which is often seen in complicated pregnancies. Inflammation in complicated pregnancies is directly associated with increased mortality and morbidity of the mother and offspring.[5] Accordingly, dental procedures should be carefully selected for pregnant women.
Financial support and sponsorship
This manuscript received financial support from the Ministry of Education, Culture, Sports, Science and Technology (MEXT)-Supported Program for the Strategic Research Foundation at Private Universities, 2015-2019 concerning [The constitution of total researching system for comprehensive disaster, medical management, corresponding to wide-scale disaster].
Figure 1