Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 268-270, May 2010

A Rare Complication After Microlaryngeal Surgery: Subcutaneous Emphysema and Pneumomediastinum

  • Ying-Nan Chang

      Affiliations

    • Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C.
    • ,
  • Jih-Chin Lee

      Affiliations

    • Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C.
    • ,
  • Jiann-Jy Chen

      Affiliations

    • Department of Otorhinolaryngology, Taoyuan Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan, R.O.C.
    • Faculty of Medicine, Fu Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Yaoh-Shiang Lin

      Affiliations

    • Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C.
    • Medical Affairs Bureau, Ministry of National Defense, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Yaoh-Shiang Lin, Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan, R.O.C.

Received 21 October 2009; accepted 10 March 2010.

Microlaryngeal surgery is a common and relatively safe otorhinolaryngological surgery. Its common complications include pain and numbness of the tongue, bruising of the lip, and chipped teeth. However, reports of subcutaneous emphysema of the neck with pneumomediastinum following microlaryngeal surgery are rare. A 69-year-old female developed swelling of her left-side cheek and neck after microlaryngeal surgery for anterior glottic web. Palpation revealed subcutaneous emphysema and computed tomography demonstrated pneumomediastinum. The patient was managed conservatively, with complete resolution of symptoms within 2 weeks. Our observations suggest that emphysema likely resulted from increased intrapharyngeal pressure secondary to coughing, vomiting, straining, or manual ventilation after extubation provoked by disruption of the pharyngeal mucosa over the left anterior tonsillar pillar during insertion of the laryngoscope. Although microlaryngeal surgery is considered a relatively safe surgical procedure, it may be associated with significant complications. The procedure should be performed carefully to prevent mucosal injury.

Key Words:  microlaryngeal surgery , pneumomediastinum , subcutaneous emphysema

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PII: S1726-4901(10)70058-7

doi:10.1016/S1726-4901(10)70058-7

Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 268-270, May 2010

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