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Alzamil AF, Bedawi FK, AlAseeri DA, Almulla E, Alrayyes HY, Riskalla A. Subcutaneous Emphysema Following Tonsillectomy: A Rare Complication of a Common Surgery. Cureus 2024; 16:e53825. [PMID: 38465092 PMCID: PMC10924276 DOI: 10.7759/cureus.53825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Post-tonsillectomy emphysema is an infrequent yet critical complication that follows tonsillectomy - a prevalent surgical procedure for treating conditions like recurrent tonsillitis and obstructive sleep apnea. While tonsillectomy is generally safe, it is not without risks, including the rare occurrence of postoperative emphysema, where air accumulates abnormally in the neck and head's soft tissues, potentially leading to severe respiratory distress. We present a case of a middle-aged female who underwent tonsillectomy and subsequently developed symptoms indicative of post-tonsillectomy emphysema. Diagnosed through a combination of physical examination and imaging, her treatment involved conservative management and careful monitoring, ultimately resulting in full recovery without the need for surgical intervention.
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Affiliation(s)
- Abdulrahman F Alzamil
- Otolaryngology - Head and Neck Surgery, Bahrain Royal Medical Services, Riffa, BHR
- Otolaryngology - Head and Neck Surgery, King Hamad University Hospital, Manama, BHR
| | - Fahad K Bedawi
- Otolaryngology - Head and Neck Surgery, King Hamad University Hospital, Manama, BHR
| | - Danya A AlAseeri
- Otolaryngology - Head and Neck Surgery, King Hamad University Hospital, Manama, BHR
| | - Ebrahim Almulla
- Otolaryngology - Head and Neck Surgery, King Hamad University Hospital, Manama, BHR
| | - Hesham Y Alrayyes
- Otolaryngology - Head and Neck Surgery, King Hamad University Hospital, Manama, BHR
| | - Andrew Riskalla
- Otolaryngology - Head and Neck Surgery, King Hamad University Hospital, Manama, BHR
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2
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Assiri H, Ibrahim Y, Alghulikah A. Surgical Neck Emphysema Post Elective Tonsillectomy: Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2022:1455613211069352. [PMID: 34991367 DOI: 10.1177/01455613211069352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Neck emphysema after tonsillectomy surgery is very rare. We present a case documenting the conservative management of a post-tonsillectomy neck swelling, accompanied by crepitus. Computed tomography revealed a large air density at the region of the right masticator space and the masseter muscle, proximal to other deep neck spaces and muscles. Further investigations of her associated symptoms resulted in an additional diagnosis of systemic lupus erythematosus. We have also explored the signs and symptoms associated with such cases, along with a discussion of the literature published on surgical emphysema post-tonsillectomy.
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Affiliation(s)
- Hassan Assiri
- Otorhinolaryngology, Head and Neck Surgery Department, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Yaser Ibrahim
- ENT, 48061Security Forces Hospital, Riyadh, Saudi Arabia
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3
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Barengo JH, Yuen SN, Kennedy P, Shott SR. Subcutaneous emphysema with pneumomediastinum after tonsillectomy: Case report and review of the literature. Int J Pediatr Otorhinolaryngol 2020; 131:109885. [PMID: 31981917 DOI: 10.1016/j.ijporl.2020.109885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Subcutaneous emphysema is a rare complication of tonsillectomy.We report a case of post-tonsillectomy crepitus with radiographic extravasation of contrast from the tonsil fossa into the neck, subcutaneous emphysema, pneumomediastinum and small pneumothorax in a patient with Down Syndrome. Subsequent direct laryngoscopy showed no visible defect in the mucosal or muscle layers of the tonsil fossa. We explore common presenting symptoms, clinical course, and treatment of subcutaneous emphysema secondary to tonsillectomy.
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Affiliation(s)
- Jenna H Barengo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sonia N Yuen
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Patrick Kennedy
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Sally R Shott
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA; Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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4
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De Coninck L, Goderis J, Herregods N, Vanspeybroeck S, Vermassen F, Dhont E. Massive pneumomediastinum with subcutaneous emphysema after elective adenotonsillectomy in children: Involvement of the Boyle-Davis mouth gag. Int J Pediatr Otorhinolaryngol 2019; 122:152-154. [PMID: 31029949 DOI: 10.1016/j.ijporl.2019.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/26/2022]
Abstract
Adenotonsillectomy, a very common surgical procedure in otorhinolaryngology, is considered easy and safe surgery. However, clinicians should be aware of some less common but potentially life-threatening complications. This report discusses subcutaneous emphysema with pneumomediastinum following elective adenotonsillar surgery in children. The Boyle-Davis mouth gag seemed to play a part in the pathogenic mechanism of this rare complication in this case. Better insights in the mechanism of this severe complication of adenotonsillectomy may contribute to the prevention of this complication.
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Affiliation(s)
- L De Coninck
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - J Goderis
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - N Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - F Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Dhont
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
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5
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Duvekot A, van Heesch G, Veder L. Subcutaneous and Mediastinal Emphysema Followed by Group A Beta-Hemolytic Streptococci Mediastinitis. A Complicated Course after Adenotonsillectomy: Case Report. Diagnostics (Basel) 2019; 9:diagnostics9010011. [PMID: 30650516 PMCID: PMC6468507 DOI: 10.3390/diagnostics9010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022] Open
Abstract
Tonsillectomy is a commonly performed surgery in the daily practice of an otorhinolaryngologist. For patients as well as health professionals, the best known complication is post-operative bleeding. Among the less noted, but potentially life-threatening, complications are the development of subcutaneous emphysema and the presence of bacteremia due to group A hemolytic streptococci. In this report, we describe a severely complicated clinical course after an uncomplicated adenotonsillectomy in a young boy. Increased awareness of relatively unknown complications after adenotonsillectomy amongst surgeons, pediatricians and anesthesiologists is desirable to facilitate rapid diagnosis and adequate treatment in order to prevent life-threatening situations.
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Affiliation(s)
- Anne Duvekot
- Department of Otorhinolaryngology and head and neck surgery, Erasmus Medical Center, Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands.
| | - Gwen van Heesch
- Department of Pediatrics, Pediatric Intensive Care Unit, Erasmus Medical Center, Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands.
| | - Laura Veder
- Department of Otorhinolaryngology and head and neck surgery, Erasmus Medical Center, Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands.
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Pneumomediastinum, Pneumopericardium, and Epidural Pneumatosis following Adenotonsillectomy: A Very Rare Complication. Case Rep Otolaryngol 2018; 2018:4531364. [PMID: 30210888 PMCID: PMC6120283 DOI: 10.1155/2018/4531364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/08/2018] [Accepted: 07/29/2018] [Indexed: 12/19/2022] Open
Abstract
Adenotonsillectomy is a common surgical otolaryngology procedure that is associated with several complications, including hemorrhage, odynophagia, damage to teeth, taste disorders, atlantoaxial subluxation, lingual edema, infection, and injury of the carotid artery. Pneumomediastinum, pneumopericardium, and epidural pneumatosis are an extremely unusual condition in children with adenotonsillectomy. Treatment should be conservative in the majority of cases and based on benign self-limiting course of these diseases; early recognition can prevent further complications. The combination of pneumomediastinum with epidural pneumatosis, pneumopericardium, retropharyngeal-prevertebral pneumatosis, axillar-perihumeral pneumatosis, and subcutaneous emphysema is also a very rare condition. We present a unique case with the radiological findings of air in all of these areas in a 6-year-old male child with adenotonsillectomy. The case was unusual in that the patient developed this complication 3 hours later after adenotonsillectomy with severe vomitting. The possible mechanism, the algorithm of treatment, and precautions in such cases will be discussed.
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7
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Cervicofacial emphysema following Harmonic scalpel tonsillectomy: case report and comprehensive review of the literature. The Journal of Laryngology & Otology 2016; 131:177-180. [PMID: 27989246 DOI: 10.1017/s0022215116009671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tonsillectomy is one of the most common surgical procedures performed worldwide. There are a handful of common complications, with bleeding being the most feared; however, rarer complications can present to a wide range of medical professionals. METHODS A 12-year-old girl presented with cervicofacial emphysema following tonsillectomy. This paper discusses the case and the management adopted, and presents the findings of a comprehensive literature review. RESULTS The patient made a full recovery, and was discharged after 3 days following conservative management with intravenous broad-spectrum antibiotics and supplemental low-flow oxygen. CONCLUSION This paper presents the first reported case of cervicofacial emphysema following Harmonic scalpel tonsillectomy. Although this is an exceptionally rare complication, it is potentially serious and warrants further description to improve awareness.
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8
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Kasle D, Virbalas J, Bent JP, Cheng J. Tonsillectomies and respiratory complications in children: A look at pre-op polysomnography risk factors and post-op admissions. Int J Pediatr Otorhinolaryngol 2016; 88:224-7. [PMID: 27497419 DOI: 10.1016/j.ijporl.2016.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/14/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify predictors of post-operative respiratory complications in children undergoing tonsillectomy. METHODS Consecutive case series with chart review of children who underwent polysomnography (PSG) and subsequent tonsillectomy with or without adenoidectomy for obstructive sleep apnea (OSA). Patients with craniofacial anomalies or significant cardiopulmonary comorbidities were excluded. Rates of post-surgical respiratory complication were reviewed and compared to patient specific factors and PSG findings to identify possible risk factors. RESULTS Eighty-six patients (mean age 5.3 ± 2.2 years) were included. There was a statistically significant (p = 0.03) relationship between an AHI ≥40 (AHI40) and post-operative respiratory complications. AHI40 also had the greatest magnitude of association with postoperative respiratory complications (OR = 5.313). An AHI ≥25 (AHI25) was marginally significant (p = 0.067). No significant difference in outcome occurrence was found when analyzing rates of complication in patients with BMI above and below 18 (p = 0.20) or oxygen (O2) nadir above and below 80% (p = 0.09). The AHI ranged from 0 to 112.2, and no postoperative respiratory complications were identified in children with an AHI less than 10. CONCLUSIONS Our results indicate an association between an AHI ≥40 and respiratory complications following an adenotonsillectomy, but we were not able to observe any significant difference at a cutoff of 25. An association between BMI or O2 nadir and postoperative respiratory complication was not able to be identified. Our results support the importance of AHI as a predictor of postoperative respiratory complications in children undergoing tonsillectomy for OSA.
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Affiliation(s)
- David Kasle
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jordan Virbalas
- University of Colorado, Pediatric Otolaryngology Fellow, Denver, CO, USA
| | - John P Bent
- Albert Einstein College of Medicine, Bronx, NY, USA; Otolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Jeffrey Cheng
- Pediatric Otolaryngology, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA.
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9
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Tran DD, Littlefield PD. Late presentation of subcutaneous emphysema and pneumomediastinum following elective tonsillectomy. Am J Otolaryngol 2015; 36:299-302. [PMID: 25480365 DOI: 10.1016/j.amjoto.2014.10.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 11/18/2022]
Abstract
Subcutaneous emphysema and pneumomediastinum are rare complications following elective tonsillectomy. Although the mechanism of injury is unclear, air is thought to enter through either the buccopharyngeal mucosa during surgery or via alveolar rupture during positive pressure ventilation. Patients typically present immediately after surgery or upon anesthesia emergence. We describe a case of delayed pneumomediastinum in a 30year-old female who presented 4days after surgery. With only one other case described, we review the literature and remind the reader to be cognizant of this late complication.
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Affiliation(s)
- Daniel D Tran
- Major, Medical Corps, US Army; Department of Otolaryngology; Tripler Army Medical Center; Honolulu, Hawaii.
| | - Philip D Littlefield
- Lieutenant Colonel, Medical Corps, US Army; Chief, Otology/Neurotology; Tripler Army Medical Center; Honolulu, Hawaii
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10
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Bizaki A, Kääriäinen J, Harju T, Rautiainen M. Facial subcutaneous emphysema after tonsillectomy. Head Face Med 2014; 10:11. [PMID: 24725343 PMCID: PMC3989797 DOI: 10.1186/1746-160x-10-11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/31/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tonsillectomy is a commonly performed and relatively safe surgical procedure. However, it can potentially be associated with several complications. We report a case of facial subcutaneous emphysema that occurred after elective tonsillectomy. CASE Tonsillectomy was performed on a patient with a history of frequent tonsillitis. After surgery, the patient developed facial subcutaneous emphysema that resolved within a few days without any further complications. CONCLUSION Subcutaneous emphysema is a rare complication of tonsillectomy. Tonsil should be removed along the tonsilar capsule. If its removal causes a deeper than usual mucosal tear up to the level of the muscles, then air might potentially pass through the pharyngeal wall to the parapharyngeal, retropharyngeal and prevertebral spaces.
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Affiliation(s)
- Argyro Bizaki
- Department of Otolaryngology, University Hospital of Tampere, Tampereen yliopistollinen sairaala, PL 2000, Tampere 33521, Finland.
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11
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Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc08. [PMID: 24403976 PMCID: PMC3884543 DOI: 10.3205/cto000100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN). METHODS A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. RESULTS The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age) and seven adults (aged 20 to 69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (10; 37%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials after LN procedures were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2). CONCLUSION Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged medical malpracice is proven for less than 6% before trial stage. Approximately half of all cases result in a plaintiff verdict or settlement at court. Proper documentation of a thourough counselling, examination, indication, informed consent and follow-up assists the surgeon in litigation. An adequate complication management of PTH is essential, including instructions for the patients/parents, instructions for the medical staff and readily available surgical instruments. Successful outcome of life-threatening PTH is widely based on a proper airway management in an interdisciplinary approach. Electrosurgical tonsillectomy techniques were repeatedly labeled as a risk factor for bleeding complications following TE. Institutions should analyse the individual PTH rate on a yearly basis. Contradictory expert opinions and verdicts of the courts concerning spinal accesory nerve lesions following LN are due to a lack of a surgical standard.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
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12
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Subcutaneous emphysema and pneumomediastinum after tonsillectomy. Case Rep Otolaryngol 2013; 2013:154857. [PMID: 24379978 PMCID: PMC3860152 DOI: 10.1155/2013/154857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/23/2013] [Indexed: 02/06/2023] Open
Abstract
Cervicofacial subcutaneous emphysema is a rare complication of tonsillectomy that often resolves spontaneously but may progress to obstruct upper airways or spread to the thorax causing pneumomediastinum or pneumothorax. The mechanisms by which subcutaneous emphysema and pneumomediastinum may develop after tonsillectomy are poorly understood. A case of a 21-year-old female undergoing routine adenotonsillectomy, who developed cervicofacial emphysema and pneumomediastinum, is presented. Possible pathogenetic mechanisms and treatment options are discussed.
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13
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Windfuhr JP. Serious Complications following Tonsillectomy: How Frequent Are They Really? ACTA ACUST UNITED AC 2013; 75:166-73. [DOI: 10.1159/000342317] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kim JP, Park JJ, Kang HS, Song MS. Subcutaneous emphysema and pneumomediastinum after tonsillectomy. Am J Otolaryngol 2010; 31:212-5. [PMID: 20015746 DOI: 10.1016/j.amjoto.2009.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 02/13/2009] [Accepted: 02/14/2009] [Indexed: 10/20/2022]
Abstract
Many patients and their families regard tonsillectomy as a minor operation because it is performed so commonly. However, although tonsillectomy is indeed a relatively safe surgical procedure, in extremely rare cases, it can be complicated by subcutaneous emphysema and pneumomediastinum. Although these complications resolve spontaneously in most cases, a few conclude in tension pneumothorax and other fatal complications. The mechanism by which subcutaneous emphysema and pneumomediastinum develop after tonsillectomy is poorly understood. We experienced a case in which subcutaneous emphysema, pneumomediastinum, and a deep defect in the tonsillar fossa were observed. The passage of air was shown by radiology and histopathology. Consequently, the case is reported here.
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15
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Piotrowski S, Jesikiewicz D. [Mediastinal emphysema as a complication of the tonsilloadenotomy in child]. Otolaryngol Pol 2010; 63:528-31. [PMID: 20198990 DOI: 10.1016/s0030-6657(09)70174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM OF THE PAPER Authors present the case of a 6 years old boy with rare complication of mediastinal emphysema after tonsilloadenotomy. MATERIAL AND METHODS Authors detailed describe the evolution of this complication and methods of its treatment. This complication was treated in Child's Surgery Clinic where the digestive and respiratory tracts were controlled and upper mediastinotomy with drainage of the mediastinum was performed. Subsequently, the child was treated on the Intensive Care Unit where prolonged intubation and parenteral feeding were used and was discharged completely healed after 7 days. Authors discuss possible causes of this complication as a result of injury of the pharyngeal wall during the operation due to vomits after general anastesia. RESULTS OF THE TREATMENT: Total period of treatment of this complication was 14 days. The authors deal as well with the issue of underestimating the risk associated with the operational procedures on tonsils, especially in the case of children. They also consider the possibility of performing such procedures in the one day surgery conditions. CONCLUSIONS The analysed complication associated with tonsils operation are rather unusual and its successfull treatment depends on quick and accurate diagnosis, which is possible due to meticulous postoperational care.
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Richter GT, Bower CM. Cervical complications following routine tonsillectomy and adenoidectomy. Curr Opin Otolaryngol Head Neck Surg 2006; 14:375-80. [PMID: 17099343 DOI: 10.1097/01.moo.0000247525.56076.54] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Fortunately, patients undergoing adenotonsillectomies have far more complaints than complications. Sore throats, dysphagia, and neck pain are frequent and expected symptoms after surgery. Differentiating these symptoms from early signs of severe cervical complications can be difficult. Such complications are rare but include atlanto-axial subluxation (Grisel's syndrome), cervical necrotizing fasciitis, cervical emphysema and cervical oseteomyelitis. Due to the frequency with which adenotonsillectomies are performed, most otolaryngologists will encounter these events during their career. This article is thereby intended to elucidate the early warnings, appropriate diagnostic workup, and therapeutic modalities for cervical complications following adenotonsillectomies. RECENT FINDINGS Early recognition and intervention can prevent devastating morbidity and mortality described with cervical complications. Computed tomography scanning remains the gold standard for diagnosing cervical complications after adenotonsillectomy. Although a range of severity exists in cervical complications, most cases can be managed conservatively with broad spectrum antibiotics, observation, bedrest and immobilization in cases of Grisel's syndrome. Cervical necrotizing fasciitis requires a high index of suspicion and urgent management to avoid fatal consequences. SUMMARY This is a review of the most frequently encountered, although rare, cervical complications following adenotonsillectomies. It gives the reader an insight into the efficient diagnosis and management of these complications.
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Affiliation(s)
- Gresham T Richter
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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