Subcutaneous Emphysema as a Complication of Tonsillectomy: A Systematic Literature Review and Case Report

Abstract

Introduction: Subcutaneous and mediastinal emphysema is a rare complication after tonsillectomy. This case presentation and literature review summarizes the existing literature on this unusual complication.

Materials and methods: This study presents a case of a 21-year-old man who developed a cervical subcutaneous emphysema 6 days after tonsillectomy, whereby conservative treatment produced spontaneous resolution. A proper analysis of this case also required undertaking a systematic search in MEDLINE/PubMed and SCOPUS electronic databases concerning this rare complication, without language restrictions.

Results: Based on our criteria, we identified 41 reports including 43 individual cases, in which patients were mostly young and equally distributed between the genders (18 males and 23 females, two unknown). The treatment was mainly conservative and consisted of observation and/or antibiotic therapy.

Conclusion: Subcutaneous or mediastinal emphysema is an uncommon complication after tonsillectomy. It is important that clinicians become aware of this rare complication, which requires a close monitoring of the patient.

Keywords: Mediastinal Emphysema; Subcutaneous Emphysema; Tonsillectomy.

Fig 1

Computed tomography scan in the axial and sagittal planes showing air in the cervical subcutaneous tissues on both sides of the neck, especially on the left. There is also interruption of the air column in the left tonsillar lodge

Fig 2

Flow chart presenting the design of the systematic review.

Fig 3

Box plot showing the median and range of the age concerning the occurrence of the subcutaneous emphysema. A statistical analysis showed no significant difference for age of occurrence between the genders, with a p-value of 0.525

Fig 4

Histogram presenting the different methods of treatment of the subcutaneous emphysema. The treatment was either conservative, including observation and/or antibiotic therapy or interventional/surgical with re-intubation, tracheostomy or thoracotomy. Two patients required a thoracotomy, three patients a re-intubation and one patient required a temporary tracheostomy

Fig 5

Time of occurrence of subcutaneous emphysema after tonsillectomy. In the majority of cases, the complication occurred on the operation day or on the first postoperative day

Fig 6

Palatine tonsil and its surrounding fasciae