A rare complication after microlaryngeal surgery: subcutaneous emphysema and pneumomediastinum

Microlaryngeal surgery is a common and relatively safe otorhinolaryngological surgery. Its common complications include pain and numbness of the tongue, bruising of the lip, and chipped teeth. However, reports of subcutaneous emphysema of the neck with pneumomediastinum following microlaryngeal surgery are rare. A 69-year-old female developed swelling of her left-side cheek and neck after microlaryngeal surgery for anterior glottic web. Palpation revealed subcutaneous emphysema and computed tomography demonstrated pneumomediastinum. The patient was managed conservatively, with complete resolution of symptoms within 2 weeks. Our observations suggest that emphysema likely resulted from increased intrapharyngeal pressure secondary to coughing, vomiting, straining, or manual ventilation after extubation provoked by disruption of the pharyngeal mucosa over the left anterior tonsillar pillar during insertion of the laryngoscope. Although microlaryngeal surgery is considered a relatively safe surgical procedure, it may be associated with significant complications. The procedure should be performed carefully to prevent mucosal injury.