2020 Volume 113 Issue 1 Pages 53-59
Subcutaneous emphysema occasionally occurs during head and neck surgery. While it resolves spontaneously in many cases, in some, the condition progress to mediastinal emphysema, and preventive measures against infections, such as mediastinitis, are needed. Case 1 was a 60-year-old man who had undergone emergency tracheotomy. After the surgery, he had persistent dyspnea and complained of anterior chest pain. A chest CT revealed subcutaneous and mediastinal emphysema. Furthermore, the patient also developed bilateral pneumothorax. Case 2 was a 70-year-old woman who had undergone transoral videolaryngoscopic surgery (TOVS) for cancer of the pyriform sinus of the left side. After the surgery, she also developed persistent anterior chest discomfort and continuous coughing. A chest CT obtained on the following morning revealed emphysema of the subcutaneous, mediastinal and retroperitoneal spaces. Fortunately, the condition resolved spontaneously in both the patients, without any severe infections. Based on our observations, we consider that emergency tracheotomy and resection of the anterolateral part of the pyriform sinus during TOVS are risk factors for the development of severe subcutaneous emphysema.
