Surgical Neck Emphysema Post Elective Tonsillectomy: Case Report and Literature Review

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.

Pneumomediastinum, Pneumopericardium, and Epidural Pneumatosis following Adenotonsillectomy: A Very Rare Complication

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.

Cervicofacial emphysema following Harmonic scalpel tonsillectomy: case report and comprehensive review of the literature

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.

Subcutaneous emphysema and pneumomediastinum after tonsillectomy

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.

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.

Cervical complications following routine tonsillectomy and adenoidectomy

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.