The Rare Occurrence of Post-tonsillectomy Surgical Emphysema

Abstract

Subcutaneous facial emphysema is a rare complication of tonsillectomy that can lead to infection, upper airway obstruction or invasion into the thorax. The latter can cause pneumomediastinum or pneumothorax, with possible subsequent cardiorespiratory function impairment. Although multiple causes are suggested in the literature, the main causative factor is still unclear. Moreover, the rationale for its management is inconsistent and the outcomes are unpredictable. We report a case of a 14-year-old pediatric male patient, known to have a hypersensitive gag reflex, who developed post-tonsillectomy cervicofacial subcutaneous emphysema; management has achieved complete clinical resolution after two weeks of complication onset. Additionally, we present a literature review that showcases the potential causes and management of subcutaneous emphysema.

Exceptional post-tonsillectomy cervicofacial emphysema: A case report

“…Thus, air enters through the iatrogenic defect and travels through the cervicofacial planes to the parapharyngeal, retropharyngeal, and prevertebral spaces [ 8 , 9 ]. Air may descend to the mediastinum through the deep neck spaces causing a pneumomediastinum, or/and to the pleural space resulting in a pneumothorax [ 8 ].…”

“…Post-tonsillectomy emphysema's main clinical characteristic is a non-tender cervicofacial swelling with crepitus on palpation. If the patient also developed dyspnea, dysphagia, chest and back pain, cyanosis and Hamman's sign (crepitus synchronous with systole), pneumomediastinum should be suspected [ 8 ]. Chest X-ray readily detects the subcutaneous air.…”

“…In this rationale, laxatives, cough suppressants or antihistaminic drugs may be prescribed. Most authors agree that the administration of broad-spectrum antibiotherapy is obligatory to prevent contamination from oral cavity [ 5 , 8 ].…”