A Pregnant Woman with Pneumomediastinum after Tooth Treatment

Dear Editor, A 35‐year‐old pregnant woman experienced right inferior molar pain and underwent dental treatment (including drill and laser treatment) under local anesthesia using lidocaine at 30 weeks of gestation. After this treatment, she felt face and neck swelling with dyspnea. She was transferred to our department by ambulance due to the suspicion of an anaphylactic reaction. Her medical and family histories were unremarkable. On arrival, her Glasgow Coma Scale score was 15. She had a blood pressure of 108/68 mmHg, heart rate of 67 beats/min, respiratory rate of 20 breaths/min, and SpO2 of 100% with oxygen (3 L/min). Subcutaneous crepitus was observed under the skin along the anterior chest wall and neck without skin lesions. The fetal heart rate was 110–160 beats/min and she was experiencing frequent uterine contractions. Computed tomography revealed subcutaneous emphysema and pneumomediastinum from the neck to the mediastinum [Figure 1]. She was admitted in hospital and an infusion of cefazolin and ritodrine was administered to prevent descending mediastinitis and abortion. Her symptoms subsided within a few days and she was discharged on the 4th day of hospitalization.