Case report: Subcutaneous emphysema following postoperative nausea

Subcutaneous emphysema is a rare but potentially serious complication in dentistry and oral surgery resulting from the introduction of air into soft tissues. Although commonly associated with forward venting air-driven handpieces, cases have also been reported in the absence of an identifiable air source. We report an 18-year-old female who developed extensive subcutaneous emphysema following routine extraction of four third molars performed without the use of forward venting air-driven instruments, after multiple episodes of postoperative retching and emesis. She presented with progressive facial swelling and was transferred to a tertiary care center. Imaging demonstrated widespread air tracking within the masticator and submandibular spaces without abscess. The patient was managed conservatively with intravenous antibiotics, sinus precautions, and supportive care, with gradual resolution. Although uncommon, subcutaneous emphysema warrants vigilance due to risks of mediastinal spread and airway compromise. This case highlights that postoperative nausea and emesis may introduce air into unhealed extraction sites and emphasizes the importance of early recognition and prompt management.