The use of a high-speed air rotor with air-water spray to cut bone or section teeth, especially when a mucoperiosteal flap has been elevated, has been known to cause (rarely) the complication of subcutaneous emphysema, which is the dissection of air into and under the tissues. The collections of air can dissect superiorly to involve the cavernous sinus (extremely rare) or inferiorly to involve the mediastinum (somewhat less rare).
Hayman and Babayof’s 1995 article, “Emphysematous Complications in Dentistry, 1960-1993: An Illustrative Case and Review of the Literature,” published in Quintessence International, reported on 74 cases of emphysematous complications in ambulatory dental patients published in the English literature between 1960 and 1993. Subcutaneous emphysema occurred mainly in patients in the third and fifth decades of life, after dental procedures on the third molar, in particular during mandibular extractions and treatment on the right side. The use of an air syringe, high-speed handpiece, or their combination was reported in 71 percent of cases. Air dissection, with retropharyngeal and mediastinal emphysema, occurred in 35 percent of the patients, especially following extractions.
The use of an air syringe, a high-speed handpiece, or their combination was reported in 71 percent of cases of emphysematous complications in ambulatory dental patients between 1960 and 1993.
Additionally, in March 2016, CDC released an updated Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, which provides the following recommendation for surgical irrigation: "During surgical procedures, use only sterile solutions as coolant/irrigant using an appropriate delivery device, such as a sterile bulb syringe, sterile tubing that bypasses dental unit waterlines, or sterile single-use devices.” Examples of surgical procedures include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extraction of teeth.
Because of these risks and recommendations, clinics should consider developing a policy requiring the use of sterile solutions during surgeries and dedicated surgical handpieces whenever a handpiece must be used in the presence of a mucoperiosteal flap. Examples of appropriate surgical handpieces include: