Surgical emphysema and pneumomediastinum following mastoidectomy

Dayasena, R. P.; Soodin, D; Habaragamuwa, B W P; Ganthune, S

doi:10.4038/cmj.v52i4.923

Cited by 5 publications

(1 citation statement)

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“…3,7 It can also occur spontaneously [13][14][15][16][17] and has been reported to result from Valsalva maneuvers after cochlear implantation [8][9][10] and from ventriculoperitoneal (VP) shunt placement. 14,18,19 Subcutaneous emphysema can follow surgery, [20][21][22][23][24] Valsalva maneuvers, 20,23,25 malfunction of air-powered instruments, 26,27 and obstructed nasal sneezes. 28…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous Emphysema and Pneumolabyrinth plus Pneumocephalus as Complications of Middle Ear Implant and Cochlear Implant Surgery

McKinnon

Watts

2013

Ear, Nose & Throat Journal

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We conducted a retrospective case review at a tertiary academic medical center for the complications of pneumolabyrinth with pneumocephalus and subcutaneous emphysema after surgery for middle ear and cochlear implants. Charts of 76 cochlear implant and 2 middle ear implant patients from January 2001 through June 2009 were reviewed. We identified 1 cochlear implant recipient with pneumolabyrinth and pneumocephalus, and 1 middle ear implant recipient with subcutaneous emphysema. Surgical exploration was performed for the pneumolabyrinth with pneumocephalus; the subcutaneous emphysema was managed conservatively. The patient with the cochlear implant, who had had a ventriculoperitoneal shunt placed, experienced pneumolabyrinth with pneumocephalus 6 years after uneventful surgery. Middle ear exploration revealed no residual fibrous tissue seal at the cochleostomy. The middle ear and cochleostomy were obliterated with muscle, fat, and fibrin glue. The ventriculoperitoneal shunt was deactivated, with clinical and radiographic resolution. On postoperative day 5, the patient who had undergone the middle ear implant reported crepitance over the mastoid and implant device site after repeated Valsalva maneuvers. Computed tomography showed air surrounding the internal processor. A mastoid pressure dressing was applied and the subcutaneous emphysema resolved. These 2 cases support the importance of recognizing the clinical presentation of pneumolabyrinth with associated pneumocephalus, as well as subcutaneous emphysema. Securing the internal processor, adequately sealing the cochleostomy, and providing preoperative counseling regarding Valsalva maneuvers and the potential risk of cochlear implantation in the presence of a ventriculoperitoneal shunt may prevent adverse sequelae.

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