Fukuda Haruki, Fukushima Kazunori, Takahashi Yoichiro, Hayakawa Akira, Tokue Hiroyuki, Obana Yuta, Iwahara Kaori, Tsuzuki Tamiyuki, Yokoo Satoshi, Sano Rie
Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511 Japan.
Department of Emergency Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511 Japan.
Leg Med (Tokyo). 2025 Sep;77:102674. doi: 10.1016/j.legalmed.2025.102674. Epub 2025 Jul 5.
Air embolism during dental treatment is a rare but severe complication. We report a woman in her 70 s who died of an air embolism. The patient experienced sudden stiffness and loss of consciousness while undergoing restorative treatment for cervical caries of the lower right second molar. Despite resuscitation efforts, the patient died 2 h later. Postmortem computed tomography revealed subcutaneous emphysema from the right mandible to the cervical area; gas within the right mandibular canal; and expansion of the right submental vein extending to the right anterior jugular vein, brain, cervical vessels, and heart chambers. An autopsy revealed mucosal abrasions and bleeding around the gingival mucosa, gas in the cerebral and cervical vessels, and an open oval foramen in the atrial septum. Histopathological examination revealed emphysematous and exudative changes in the granulation tissue and empty veins, indicating the presence of air surrounding the lower right second molar. In this case, routine dental treatment resulted in a fatal outcome, which was attributed to the following. First, the patient had fragile periodontal tissue, which made it prone to air infiltration. Second, the patent foramen ovale allowed air to pass from the venous to the arterial system, leading to systemic and cerebral air embolisms.
牙科治疗期间发生空气栓塞是一种罕见但严重的并发症。我们报告了一名70多岁死于空气栓塞的女性。该患者在接受右下第二磨牙颈部龋齿修复治疗时突然出现僵硬和意识丧失。尽管进行了复苏努力，患者仍在2小时后死亡。死后计算机断层扫描显示从右下颌骨到颈部区域的皮下气肿；右下颌管内有气体；右颏下静脉扩张延伸至右颈前静脉、脑、颈部血管和心腔。尸检发现牙龈黏膜周围有黏膜擦伤和出血，脑和颈部血管中有气体，房间隔有开放的卵圆孔。组织病理学检查显示肉芽组织和空静脉有气肿和渗出性改变，表明右下第二磨牙周围存在空气。在本病例中，常规牙科治疗导致了致命后果，原因如下。首先，患者牙周组织脆弱，容易发生空气渗透。其次，卵圆孔未闭使空气从静脉系统进入动脉系统，导致全身和脑空气栓塞。
