Spontaneous subcutaneous emphysema of the neck and mediastinum

An unusual case of spontaneous subcutaneous emphysema and pneumomediastinum presumably caused by a laryngeal or hypopharyngeal tear during excessive phonation is presented. The patient was treated conservatively after a careful search for any causative factors. Observation, with parenteral ailimentation, intravenous antibiotics, and voice rest, is advocated for most cases. Tracheostomy and open repair or mediastinotomy are reserved for the unusually severe or unresolving case.