Third molar extraction is a common oral surgery performed in the pediatric population. Here we report a case of extensive subcutaneous emphysema of the orbital, masticator, parapharyngeal, retropharyngeal spaces, bilateral carotid and visceral spaces, and pneumomediastinum after third molar extraction with turbine drill. This was treated with intubation for airway protection, transoral drainage, and intravenous antibiotics. After discharge the patient reported persistent dysphonia and was found to have left vocal fold paresis. This was likely related to extensive pneumomediastum causing injury to the recurrent laryngeal nerve. This is the first report of cervicofacial emphysema leading to vocal cord paresis after third molar extraction, demonstrating the importance of serial clinical monitoring in these cases.