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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 2024; 103:565-571. [PMID: 34991367 DOI: 10.1177/01455613211069352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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
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2
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Kharrat G, Ferchichi S, Jebahi S, Trabelsi B, Meherzi S. Exceptional post-tonsillectomy cervicofacial emphysema: A case report. Int J Surg Case Rep 2024; 120:109866. [PMID: 38889514 PMCID: PMC11231585 DOI: 10.1016/j.ijscr.2024.109866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Tonsillectomy is known as one of the safest otorhinolaryngology surgery procedure. Rarely, it can lead to serious complications. Cervico-facial emphysema is an exceptional complication of tonsillectomy. Here we reported a case of post-tonsillectomy emphysema. Our objective was to emphasize the different characteristics of this entity and draw attention to the risk of potentially fatal respiratory complications. PRESENTATION OF CASE A 46-year-old healthy woman had a tonsillectomy because of recurrent tonsillitis. Four hours after extubation, she presented a subcutaneous emphysema under the left mandibular angle, slightly extended to the left cheek and left laterocervical region. An immediate cervicofacial CT scan showed a dissecting cervical emphysema of the left hemiface of moderate abundance that extended to the pre-vascular space of the superior mediastinum. The decision was to keep the patient hospitalized, to avoid forced glottic closure and to put her on prophylactic antibiotics. The further course was uneventful with respiratory state stability and emphysema's disappearance. CLINICAL DISCUSSION Cervicofacial emphysema is a very rare but life-threatening tonsillectomy complication that may cause acute respiratory failure. Emphysema's main clinical characteristics are a non-tender cervicofacial swelling and crepitus. Post-tonsillectomy emphysema treatment is usually conservative. In cases of respiratory failure, it is necessary to secure the airway by intubation or tracheostomy. An important mediastinal expansion of the emphysema requires a thoracotomy. CONCLUSION Cervicofacial emphysema is an unpredictable complication of tonsillectomy. Its prevention requires per-operative vigilance from both ENT surgeons and anesthetists. Moreover, early diagnosis and management are essential to avoid its potentially fatal consequences.
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Affiliation(s)
- G Kharrat
- ENT Department, Mohamed Taher Maâmouri Universitary Hospital, Nabeul, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.
| | - S Ferchichi
- ENT Department, Mohamed Taher Maâmouri Universitary Hospital, Nabeul, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia
| | - S Jebahi
- ENT Department, Mohamed Taher Maâmouri Universitary Hospital, Nabeul, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia
| | - B Trabelsi
- Intensive Care Department, Mohamed Taher Maâmouri Universitary Hospital, Nabeul, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia
| | - S Meherzi
- Regional Hospital of Sidi Bouzid, Tunisia
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3
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Liu Y, Yan Z, Guo H, Xu Q, Li Z, Lin J. Rare and fatal complications of tonsillectomy: sudden pneumothorax and extensive subcutaneous emphysema. J Int Med Res 2022; 50:3000605221112369. [PMID: 35891577 PMCID: PMC9340339 DOI: 10.1177/03000605221112369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Tonsillectomy is a common, minimally invasive, and relatively safe surgical operation.
Although the surgical technology for such minor operations is mature and widely available
in most countries worldwide, postoperative adverse complications occur and may be
hazardous and fatal. Our article presents the details of a 4-year-old boy who suddenly
developed pneumothorax and systemic extensive subcutaneous emphysema after tonsillectomy.
He received professional treatment from a multi-disciplinary team (MDT) and timely rescue
in our hospital; however, he died tragically. To this end, there is an urgent need to
raise clinicians’ awareness of the potentially fatal and rare complications that can occur
after tonsillectomy.
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Affiliation(s)
- Yanquan Liu
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Zhimin Yan
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Huidong Guo
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qinglin Xu
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Zuotao Li
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Jie Lin
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
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Paouris D, Kunzo S, Šebová I. Subcutaneous emphysema with pneumomediastinum after elective tonsillectomy - Case study. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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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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Boiko NV, Tyukin YV, Fldzhyan LY. [Subcutanious emphysema and pneunomediastinum - the rare complication of tonsillectomy]. Vestn Otorinolaringol 2019; 84:81-84. [PMID: 31793533 DOI: 10.17116/otorino20198405181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tonsillectomy is one of the most common surgical interventions in the practice of ENT hospitals. As a rule, complications of tonsillectomy are early and late postoperative bleeding. However, in extremely rare cases tonsillectomy can be complicated by subcutaneous emphysema and pneumomediastinum. The mechanism by which these complications develop are poorly understood. The article describes the case of a rare complication of tonsillectomy - the intraoperative development of subcutaneous emphysema and pneumomediastinum. Such complications are most likely caused by deep trauma of the pharyngobasilar fascia of the tonsillar fossa, which causes the penetration of the air into the parapharyngeal space and its subsequent spread to the mediastinum.
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Affiliation(s)
- N V Boiko
- Rostov State Medical University, Rostov-on-Don, Russia, 344022
| | - Yu V Tyukin
- City hospital #1, named after N.A. Semashko, Rostov-on-Don, Russia, 344010
| | - L Yu Fldzhyan
- City hospital #1, named after N.A. Semashko, Rostov-on-Don, Russia, 344010
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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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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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Cha D, Lee YW, Cho HJ. A Rare Case of Subcutaneous Emphysema following Lateral Pharyngoplasty for Obstructive Sleep Apnea. JOURNAL OF RHINOLOGY 2018. [DOI: 10.18787/jr.2018.25.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Dongchul Cha
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-woo Lee
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
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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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Erol O, Aydın E. A Rare Complication of Tonsillectomy: Subcutaneous Emphysema. Turk Arch Otorhinolaryngol 2016; 54:172-174. [PMID: 29392042 PMCID: PMC5782958 DOI: 10.5152/tao.2016.1888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 11/06/2016] [Indexed: 12/30/2022] Open
Abstract
Tonsillectomy is one of the surgical procedures that are frequently performed by ear, nose, and throat surgeons. The procedure is associated with many intraoperative and postoperative complications, and the nature of the operation site hampers surgical interventions. Cervicofacial subcutaneous emphysema is characterized by the presence of air within the fascial planes of the head-neck region because of various reasons. It may develop iatrogenically or spontaneously because of trauma. Herein, we report a 4-year-old male patient who presented to our clinic with complaints of frequent tonsillitis and snoring and who developed subcutaneous emphysema involving only the maxillofacial region following tonsillectomy. In addition, treatment strategies have been discussed, taking current literature into account.
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Affiliation(s)
- Ozan Erol
- Department of Otorhinolaryngology, Başkent University School of Medicine Hospital, Ankara, Turkey
| | - Erdinç Aydın
- Department of Otorhinolaryngology, Başkent University School of Medicine Hospital, Ankara, Turkey
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