Subcutaneous emphysema and mediastinitis: unusual complications of tonsillectomy

Subcutaneous emphysema and mediastinitis are rarely reported complications of tonsillectomy.

We describe two patients who developed subcutaneous emphysema, one of them with mediastinitis, within a few days after tonsillectomy. The diagnosis was based on the clinical presentation and confirmed by computed tomography (CT). For the patient without mediastinitis, the emphysema disappeared after a short period of reintubation and administration of antibiotics. For the patient with mediastinitis, surgical drainage of a cervico-mediastinal purulent collection was necessary to obtain healing.

The events leading to subcutaneous emphysema and mediastinitis have not been entirely clarified. They probably include direct introduction of air into the neck via either the tonsillar bed or a laryngeal or pharyngeal wound caused by intubation. The clinical presentation, treatment and possible pathophysiology of subcutaneous emphysema and medisastinits are discussed.

Emphysema and mediastinitis after tonsillectomy occur seldomly. If rapidly recognised and appropriately managed, mortality can be avoided.