Surgical emphysema following third molar extraction in a patient with gilles de la tourette's syndrome

Surgical emphysema is a well-documented, rare complication of dental procedures ranging from dental extractions, to crown preparations and endodontic treatment.¹ For this to occur, air must be forced under pressure through a breach in the oral mucosa into the submucosal tissue. Most commonly this follows raising of a mucoperiosteal flap. Air can also travel more widely via deep fascial planes to the pleural and mediastinal spaces.²

Tourette's syndrome is a neurological condition characterized by repetitive involuntary noises and movements called tics, that occur for at least one year.³ These may be simple or complex, depending on the types of movement and sounds made. They are thought to increase in frequency when the individual experiences anxiety or excitement. It was originally described by French neurologist Gilles de la Tourette in 1885. The cause of this syndrome is unknown but thought to be due to misfiring in the basal ganglia. Approximately 1 in 100 people are affected by Tourette's.⁴ It is typically first noted in childhood at around 7 years of age.⁵ It usually resolves spontaneously, but can be a life-long condition in around one third of patients. Treatment includes behavioural therapy to reverse tic habits and pharmacological therapy. Despite these treatments, some cases remain refractory.³