Potential life-threatening complication of tonsillectomy: cervicofacial surgical emphysema

Abstract

A 30-year-old woman presented to the accident and emergency department 3 days post-tonsillectomy with bleeding from the tonsillar fossa and left-sided facial swelling. The patient denied any dysphagia or breathing difficulties but experienced pain on neck movement. On examination, although the bleeding had stopped on reaching the emergency department, a small clot was noted in her left tonsillar fossa. A left facial/submandibular swelling was seen, which had been present since her operation and was slowly enlarging. Flexible nasendoscopy showed a mild left sided oropharyngeal swelling but was otherwise normal. She was treated initially with antibiotics and hydrogen peroxide gargles. After 24 hours of observation and a slight worsening of the swelling she underwent a CT of the neck. This showed widespread indurated subcutaneous surgical emphysema, originating from the left tonsillar bed. Following a period of observation and improvement in her symptoms, she was discharged home with safety netting.

Rare and fatal complications of tonsillectomy: sudden pneumothorax and extensive subcutaneous emphysema

“…However, it is possible that the gas accumulation in subcutaneous emphysema may cause upper respiratory tract obstruction and spread to the thoracic cavity, leading to pneumothorax or mediastinal emphysema, which in turn induces obstructive shock. 5 , 6 Nevertheless, the mechanism of pneumothorax and subcutaneous emphysema after tonsillectomy is unclear.…”

The Rare Occurrence of Post-tonsillectomy Surgical Emphysema

“…Subcutaneous emphysema is a rare but potentially life-threatening complication of tonsillectomy [ 6 , 7 ]. Recurrent tonsillitis and positive history of peritonsillar abscess predispose to fibrosis and adhesions of the tonsillar tissue and underlying muscular layers.…”

Massive Subcutaneous Emphysema after Hydrogen Peroxide Irrigation of a Penetrating Facial Injury

“…A more recent report published in the otolaryngology literature described the development of cervicofacial emphysema following tonsillectomy. 4 This patient developed bleeding after tonsillectomy and was instructed to perform H 2 O 2 gargles. She presented 3 days later with unilateral, enlarging submandibular swelling.…”