Subcutaneous emphysema and pneumomediastinum, rare complication of tonsillectomy (clinical case)
Svistushkin V.M., Dobrotin V.E., Kochetkov P.A., Karapetyan L.S., Avetisyan E.E.
I.M. Sechenov First Moscow State Medical University

The paper describes a patient who developed subcutaneous emphysema after tonsillectomy. 29-year-old woman complained of recurrent anginas. A diagnosis of chronic tonsillitis was made based on the complaints, clinical signs, and laboratory findings. Preoperative examination revealed no comorbidities. The surgery was performed under endotracheal anesthesia. Adhesions between palatine tonsils and surrounding tissues were mild. Unlike previously published similar cases, no cough, sneezing, or positive-pressure lung ventilation were observed. In 5 hours after the surgery, swelling of the left cheek and left submandibular region was revealed. Crepitus of soft tissues in this area was detected by palpation. Spiral computed tomography confirmed subcutaneous emphysema. No airway obstruction was discovered. Subcutaneous emphysema and pneumomediastinum were diagnosed. Antibiotics (injections) were prescribed for 5 days. Subcutaneous emphysema assumed to associate with the surgery. Subcutaneous emphysema gradually regressed and disappeared by day 7. Crepitus is considered as a specific symptom of this condition while the air is better recognized by computed tomography. To prevent such complications, palatine tonsils should be carefully and non-traumatically separated from the niche. The niche should be removed strictly by the borders of pseudocapsule. The trauma of deep soft tissues can result in air penetration through the throat walls into the peripharyngeal, retropharyngeal, and prevertebral spaces.

Key words: tonsillectomy, complications, subcutaneous emphysema.

For citation: Svistushkin V.M., Dobrotin V.E., Kochetkov P.A. et al. Subcutaneous emphysema and pneumomediastinum, rare complication of tonsillectomy (clinical case) // RMJ. 2016. № 21. P. 1455–1458.