Subcutaneous emphysema is considered to be an uncommon complication of tonsillectomy. I found very few reported cases, and observed only one case among a total of more than 1300 tonsllectomized cases who were operated by my own hand. A case report is presented here to bring attention to this alarming but rarely dengerous condition.
A six years old Korean boy developed subcutaneous emphysema localizing in the cheek and upper neck following uneventful T & A under general anesthesia. The course was nothing serious one. According to literatures, subcutaneous emphysema following tonsillectomy occurs under a wide variety of conditions. It appears in all age groups, both sexes and under both local and general` anesthesia. Ordinarily no serious coplication arise but a few cases were reported where respiratory embarrassment from mediasternal emphysema and subsequent pneumothorax presented a threat to life.
Excessive trauma, to the tonsillar bed during surgery has not been an important etiologic factor in most of the reported cases. There is, however, a frequent incidence in reported cases of severe vomiting, coughing and occasionally high gas pressure applied to the pharynx or directly to the lung with anesthesia apparatus.
There are two mechanism explaining this phenomenon. The one that appears to account for most of the cases is brought about by pulmonary alveolar rupture, which in turn causes pulmonary interstitial emphysema that dissects its way to the mediastinum and neck. A second and less common me ehanism is that of air dissection through a defective tonsillar bed. In the face of increased oropharyngeal pressure caused by nausea, vomiting, coughing, the air breaks through the superior constrictor muscle of the pharynx and buccinator fascia into the loose areolar tissue of the cheek and neck.
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