# Subcutaneous Emphysema Following Periodontal Interventions: A Comprehensive Literature Review and Clinical Considerations

## TL;DR

This paper reviews cases of subcutaneous emphysema after periodontal treatments and identifies air-powder devices as a common cause.

## Contribution

The study systematically identifies device-related factors in subcutaneous emphysema following periodontal interventions.

## Key findings

- Air-powder abrasive devices caused subcutaneous emphysema in 66.7% of cases.
- Mediastinal spread occurred in 41.7% of reported cases.
- Most cases resolved within 5 days with prophylactic antibiotics.

## Abstract

Background/Objectives: Subcutaneous emphysema is a rare but potentially life-threatening complication of dental procedures caused by the penetration of pressurized air into submucosal tissues and its spread through cervicofacial and mediastinal spaces. This review aimed to summarize all reported cases of subcutaneous emphysema following periodontal interventions and to identify procedure and device-related etiologic factors associated with its occurrence. Methods: A comprehensive literature search was conducted, and case reports published between 1957 and 2025 were included without language restrictions. Cases related to trauma, maxillofacial surgery, endodontic, restorative, or prosthetic procedures were excluded. Results: A total of 34 publications reporting 36 clinical casesmet the inclusion criteria. The median patient age was 48 years (range: 8–76), and 66.7% of cases occurred in female patients. Air-powder abrasive devices were the most frequently implicated etiologic factor (66.7%), followed by dental lasers (11.1%) and air-water syringes (8.3%). Mediastinal spread was reported in 41.7% of cases. Most patients received prophylactic antibiotic therapy, and the median resolution time was 5 days (range: 3–14). Conclusions: Subcutaneous emphysema following periodontal interventions is most frequently reported in association with the use of pressurized air-driven devices, particularly air-powder abrasive systems. Although the clinical course described in the included cases was generally benign, the observed patterns highlight the relevance of procedural and device-related factors in the development and extent of this complication.