Dental Procedure-Related Emphysema: A Scoping Review of Clinical Presentation, Anatomical Distribution, Management, and Outcomes
Abstract
Background/Objectives: Dental procedure-related emphysema is an infrequently reported complication of dental care that may extend from superficial facial tissues into deep cervical, mediastinal, orbital, thoracic, intracranial, or vascular compartments. This revised scoping review aimed to map contemporary published cases using an expanded multi-database search and to characterize procedures, anatomical distribution, clinical presentation, diagnostic assessment, management, complications, and outcomes. Methods: PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched for English-language reports published from 1 January 2016 through 26 August 2026. Records were deduplicated and screened using predefined eligibility criteria; data were charted descriptively in accordance with PRISMA-ScR. Results: The expanded searches yielded 642 database records. After application of the publication window and deduplication, 246 unique records were screened. The synthesis included 109 studies describing 129 patients. The case literature remained dominated by extraction-related events, while restorative/prosthodontic treatment, dental cleaning/air-polishing, and endodontic procedures were also represented. Facial and cervical emphysema remained the most frequently reported distributions, and mediastinal and deep fascial-space extension were prominent among published cases. CT and antibiotics were frequently reported, but the case-report evidence does not establish their comparative effectiveness. Conclusions: Dental procedure-related emphysema is represented by a heterogeneous case literature with strong potential for publication bias. Sudden swelling with crepitus after dental treatment should prompt immediate assessment, with imaging and escalation guided by suspected anatomical extent and clinical severity. Reported frequencies should not be interpreted as incidence, procedure-specific risk, or evidence of treatment effectiveness.