修磨牙齒導致皮下與縱膈腔氣腫－兩病例報告

Subcutaneous and Mediastinal Emphysema Caused by Tooth Preparation-Report of Two Cases

施嘉霖(Jia-Lin Shih) ； 張燕清(Yen-Ching Chang)

《中華民國口腔顎面外科學會雜誌》 16卷2期 (2005/09) Pp. 143-155

https://doi.org/10.7104/CJOMS.200509.0143

摘要

皮下氣腫主要是皮下組織與組織間因氣體進入，導致間隙之間壓力增加所引起。若氣體進入縱膈腔的組織間隙內，使肺泡與組織間隙壓力增加則稱為縱膈腔氣腫，臨床上以胸痛為主訴，胸部X光或電腦斷層檢查中，可見縱膈腔有氣體存在。通常，兩週內氣體會自行消失，且癒後狀況佳。但若進入縱膈腔的氣體較多，則會產生較為嚴重的併發症，包括因組織內氣體壓力持續增加而壓迫到靜脈，形成缺氧、呼吸道窘迫、繼發性的感染而造成生命危險。
本文提出兩病例報告，一為27歲年輕男性，另一為39歲女性，都是在牙科診所修磨牙齒作假牙，取出排齦線，準備取模，在用氣槍吹乾時，病人突然覺得牙齒治療的同側顏面區腫痛，並開始感覺胸悶及喘不過氣，造成皮下及縱膈腔氣腫。
住院後，給予高劑量廣效性抗生素，並預防呼吸道的壓迫及給予氧氣維持適當的血氧含量。三天後，病患恢復情形良好且開始消腫，呼吸不順及胸痛的現象大部分都已消失，目前追蹤檢查良好。由於皮下氣腫在牙科治療中少見，尤其在中外文獻中，對於軟組織不做翻瓣，因為單純的牙齒修磨治療而產生的病例更是少見，特提出報告。

關鍵字

皮下氣腫 ； 縱膈腔氣腫 ； 修磨牙齒 ； 贋復治療 ； 胸痛

並列摘要

Subcutaneous cervicofacial and mediastinal emphysema are defined as the abnormal presence of air under pressure along or between facial planes involving the mediastinum. Chest pains are the chief source of complaints in these complications due to the presence of air in the mediastium, which is visible through x-rays or CT examinations. Generally, symptoms subside in two weeks and conditions are returned to normal. However, life-threatening complications such as the obstruction of airways, mediastinitis, deep neck infections and cardiac failures may arise if large amounts of air are present in the mediastium.
Two rare cases of diffuse cervicofacial and mediastinal emphysema are presented in this paper; one of a 27 year old male and another of a 39 year old female. Symptoms and complaints of chest pains from both patients were reported after the use of an air/water syringe before the impression of a single crown was taken during its preparation process at a dental clinic.
After both patients were admitted into the hospital, prophylactic antibiotics were administered while doctors began closely monitoring their vital signs and airways. After three days of treatments and a normal prognosis, both were released where symptoms had almost subsided.
The motive behind this report is that emphysema is an uncommon complication in dentistry, especially in cases of flapless dental treatment.

並列關鍵字

Subcutaneous Emphysema ； Mediastinal Emphysema ； Cervicofacial ； Tooth preparation ； Chest pain