subcutaneous emphysema risk factors?

[DocVikingo]

Hi Larry,

.... inquiry, guess I was overly focussed on the thoracic region when thinking about subcutaneous emphysema. Now that you've discussed it, doesn't really seem that much of a stretch in some dental procedures as regards areas in proximity to the mouth.

Now mediastinal emphysema from dental procedures still does strike me as a bodacious reach, but I'll keep an open mind.

Perhaps in these cases we could say...."split happens."

Best regards.

DocVikingo

 

[sunfish]

ROTFLMHO at "split happens", but as the thoracic and cervical spaces are connected, I could kind of see it happening...

 

[DocVikingo]

Given the fashion in which the body is being constructed in this thread, I'm going to have my reg free flow into a lost amalgam & blow my feet up to the point where I can't remove my fins.

Best regards.

DocVikingo

 

[sunfish]

Actually, that's a theoretical possibility if you had anorexia nervosa (bit of a zebra...more like unicorn, but there are reports of spontaneous subcutaneous emphysema in patients with anorexia nervosa).

Of course, it's highly unlikely that this is going to apply to the doc...

 

[Laurence Stein DDS]

DocVickingo,

Yeah, if you hear hoof beats, don't think of a herd of zebra...I know, I know.

I'll bet if I could poll every dentist in America today and ask if they have ever had a patient get a mediatinal emphysema, they would answer "No".

That being said, I would advise an extraction patient NOT to go scuba diving immediately following the procedure for a whole host of reasons including this possibility. No, I do not warn my periodontal patients to avoid diving because of their condition. If they had an active acute periodontal abscess, then I would warn them not to dive if they asked me.

Compressed air aimed directly into potential entry points should warrant concern. If I can cause a problem with a dental air syringe at 35 lbs/sq in pressure is problematic, what could the high volume of a deep, sudden breath do if it happened to be directed into an open lesion?

Kinda like Sunfish's example...it's not likely but if she even knows of one case, then it is a possibility. I wasn't kidding when I said that in dental school, students are admonished NOT to aim air into sockets, surgical sites or at deep periodontal pockets. I'll bet even their professors have never seen it happen.

Don't you think we've beaten this subject with a unicorn horn enough?

Geez, sometimes I'm so stubborn!

Regards,

Larry Stein

 

[DocVikingo]

I've found this very educational & appreciate the time you've put in.

Best regards.

DocVikingo

 

[Laurence Stein DDS]

Doc V,

Thank you...I feel better now. I was beginning to think I made a mountain out of a mole hill. I was just responding that it is possible not a probable outcome.

I just wasn't sure if everyone thought I was trying to quibble. I wasn't. Thanks for your vote and understanding.

Larry Stein

I gotta go and blow up some balloons now.

 

[Tommygun53]

I have blown up many of those very small balloons, the kind it really takes a lot of pressure to get started inflating, And have felt like air was going into an area of my lower left jaw on occasion.It seems that it happens easier than it used to. How does the air get into the parotid gland? Do I have an infection maybe that I need to worry about? I havent had any teeth pulled in years. Would this put me at a risk of having subq or mediastinal emphesema during a dive?





Thanks , Tom

 

[BigJetDriver]

Thank you, Dr.'s All! This is, without doubt, one of the funniest medical discussions I've ever been privy to!!

ROTFLSHIFATM (NO, IT'S NOT DIRTY!)

 

[The Iceni]

Duck, he's just entered the room!

Subcutaneous emphysema is not a diagnosis. It is a clinical sign of gas under the skin and the above discussion shows that it can arise from any number of underlying causes. (Dental "tracks" and gas gangrene to name but two.)

To my mind the important thing is to look for and regognise SE in a diver casualty and treat it as a SERIOUS problem as it is likely to be secondary to pulmonary barotrauma. (I doubt he was blowing up baloons at 20 metres!)

Now if this arises on the surface in a diver recruit, whether he is a baloonist or not, he MUST see a diving physician to exclude lung disease before he risks diving with scuba.

I, for one, would not like to suffer from PB!

Hope this helps, Jules.

(send me a PM explaining ROTFLSHIFATM to this naive Brit!)