Abstract
Hemorrhage is the most common complication after a tonsillectomy. Subcutaneous emphysema and pneumomediastinum after a tonsillectomy have only been rarely reported.
A 22-year-old female who had been sufferring from recurrent chronic tonsillitis and a right peritonsillar abscess received a tonsillectomy under general anesthesia. The tonsils were easily dissected from their beds, and a purulent discharge that was seen on the right tonsillar bed was completely suctioned. One hour after surgery, the patient's face began to swell after she had blown her nose. Four hours after surgery, her face, neck, chest and back were swollen, and palpation revealed crepitus and tenderness in these regions. A CT-scan showed the presence of subcutaneous emphysema in her face, neck, chest and back as well as air in her bilateral parapharyngeal and retropharyngeal spaces. Pneumomediastinum was also seen. Since the emphysema appeared to have been caused by the patient's blowing of her nose, she was prohibited from blowing her nose. The air was nearly completely absorbed after 7 days of conservative treatment.
Damage to the tonsillar bed during tonsillectomy, anesthesic intubation, or the use of a mouth gag can sometimes create an entry point for air into the pharyngeal spaces. In this case, the entry point was probably created by surgical trauma during the suctioning of the discharge from the right tonsillar bed. We suspect that air may have entered from the right tonsillar bed as a result of the high intrapharyngeal pressure created when the patient blowed her nose, and that the air spread to her subcutaneous areas and mediastinum through the fascia-defined spaces.
