Pneumomediastinum With Mediastinitis Following Third Molar Extraction With a High-Speed Air Handpiece: A Case Report and Literature Review

Pneumomediastinum and subcutaneous emphysema following third molar extraction are rare but potentially serious complications, often associated with the use of high-speed air-driven handpieces during dental procedures. This case report describes a 19-year-old male patient who developed pneumomediastinum, subcutaneous emphysema, deep neck, face, and mediastinal abscesses following wisdom tooth extraction with a high-speed air-driven handpiece, requiring urgent surgical intervention. The patient presented with worsening chest pain, voice changes, and facial swelling, with imaging confirming mediastinal air and abscess formation. Management included surgical incision and drainage (I&D) of the facial and neck abscesses and video-assisted thoracoscopic surgery (VATS) for the mediastinal abscess drainage, followed by admission to the intensive care unit. A review of literature from 2010 to 2025 emphasizes the rarity of this condition, with most cases linked to iatrogenic air introduction via high-speed handpieces. While the majority of cases resolve conservatively, severe complications such as mediastinitis or pneumothorax may require surgical intervention. Preventive strategies, including minimizing air-driven handpiece use and patient education on avoiding pressure-inducing activities, are crucial to reducing risk. This case highlights the importance of prompt recognition, advanced imaging, and tailored management to ensure favorable outcomes in this rare yet potentially life-threatening complication.