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Subcutaneous emphysema and pneumomediastinum complicating tonsillectomy
Alexander E Stewart1, Douglas F Brewster, Paul E Bernstein
1Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, Calif, USA. aestewart@pol.net
Background:
Subcutaneous emphysema and pneumomediastinum are very rare complications of tonsillectomy.
Objectives:
To report on a case study and a literature review of these conditions; to discuss the management and controversial causes.
Design:
Case study and literature review.
Methods:
A case is presented of subcutaneous emphysema and pneumomediastinum complicating tonsillectomy. All published reports of these complications dating back to 1910 are reviewed.
Results:
An additional 30 cases of subcutaneous emphysema and 9 of pneumomediastinum have been reported following tonsillectomy. This group of 32 patients with emphysematous complications included 17 male patients, 14 female, and a child of unknown sex. The mean age was 18.6 years (range, 2-65 years). All tonsillectomies were performed with a cold technique except our case. Subcutaneous emphysema was first noted intraoperatively in 8 patients (25%) a mean of 3.5 hours (range, 10 minutes to 14 hours) after the procedure in 18 patients (56%) and not until the next morning in 6 patients (19%). Most cases resolved without specific treatment or significant sequelae. Some cases were life-threatening and required urgent intervention. Others were misdiagnosed, which resulted in unnecessary surgery.
Conclusion:
Subcutaneous emphysema and pneumomediastinum are rare occurrences following tonsillectomy that should alert one to the possibility of more serious complications.