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ISSN 0001-0944 (Print)
Órgano Oficial de la Asociación Dental Mexicana

2018, Number 2

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Rev ADM 2018; 75 (2)

Paralysis of the XI cranial nerve following subcutaneous emphysema by use of high speed hand piece in third molar surgery

Bernal FRF, Molina TFL, Pascacio CXI, Ángel HLA

Language: Spanish
References: 28
Page: 92-97
PDF size: 285.25 Kb.


ABSTRACT

Introduction: The third molar surgery is the most frequent surgical procedure performed by oral and maxillofacial surgeons, who despite their vast experience and training in the surgical area can present transoperatory and postoperative complications. When the oral surgery is done by a general practice dentist the complications can be increased. Case presentation: A 25-year-old male patient undergoing third molar surgery by a general practice dentist who performs a surgical procedure using a high-speed handpiece. Three days after the surgical procedure patient comes to the Department of Oral and Maxillofacial Surgery Institute for Social Security and Services for State Workers by present edema, swelling and crepitus in buccal space, masseteric and right submandibular region and limitation of mouth opening of 25 mm. Contrast computed tomography shows airway deviation to the left side. We decided to manage the infectious process and subcutaneous emphysema with antibiotic therapy and drainage. After subcutaneous emphysema was in remission, in the fourth week of evolution, the patient reported limitation of abduction of the right shoulder, with atrophy of the trapezius muscle and ipsilateral sternocleidomastoid, corresponding to a lesion of the XI cranial nerve. Discussion: Accessory nerve injury (XI cranial nerve) causes palsy of the trapezius muscle, the major stabilizer of the scapula that contributes to the flexion, rotation and abduction movements of the shoulder. The trajectory of the XI cranial nerve is superficial in the posterior triangle of the neck presenting susceptibility to iatrogenic injury, in this case, the use of high-speed handpiece during the surgical extraction of the third molars, caused subcutaneous emphysema that conditioned the possible compression of the spinal nerve.


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