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Subcutaneous Emphysema and Pneumomediastinum Complicating Tonsillectomy
Alexander E. Stewart, MD;
Douglas F. Brewster, MD;
Paul E. Bernstein, MD
Arch Otolaryngol Head Neck Surg. 2004;130:1324-1327.
Background Subcutaneous emphysema and pneumomediastinum are very rare complications of tonsillectomy.
Objectives To report on a case study and a literature review of these conditions; to discuss the management and controversial causes.
Design Case study and literature review.
Methods A case is presented of subcutaneous emphysema and pneumomediastinum complicating tonsillectomy. All published reports of these complications dating back to 1910 are reviewed.
Results An additional 30 cases of subcutaneous emphysema and 9 of pneumomediastinum have been reported following tonsillectomy. This group of 32 patients with emphysematous complications included 17 male patients, 14 female, and a child of unknown sex. The mean age was 18.6 years (range, 2-65 years). All tonsillectomies were performed with a cold technique except our case. Subcutaneous emphysema was first noted intraoperatively in 8 patients (25%) a mean of 3.5 hours (range, 10 minutes to 14 hours) after the procedure in 18 patients (56%) and not until the next morning in 6 patients (19%). Most cases resolved without specific treatment or significant sequelae. Some cases were life-threatening and required urgent intervention. Others were misdiagnosed, which resulted in unnecessary surgery.
Conclusion Subcutaneous emphysema and pneumomediastinum are rare occurrences following tonsillectomy that should alert one to the possibility of more serious complications.
Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego (Drs Stewart and Brewster), and Southern California Kaiser Permanente Medical Group (Dr Bernstein), San Diego, Calif.
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