Cervicofacial emphysema and pneumomediastinum complicating adenotonsillectomy

Subcutaneous emphysema after adeno-tonsillectomy is rarely encountered. One of such cases following adenotonsilectomy was seen in our institution.

We report the case of a 5-year-old girl who developed cervicofacial emphysema and pneumomediastinum following retching and vomiting 6 hours after a routine adenotonsillectomy. Radiograph of the jaws and chest revealed subcutaneous emphysema. Previously published cases showed that the cause was most likely due to air passing into subcutaneous tissue through the tonsillar fossa and superior constrictor muscle into the facial layers of the neck following a bout of coughing and straining (crying), or the use of positive pressure ventilation. The emphysema can then spread to parapharyngeal and retropharyngeal spaces with associated morbidities. Further complications may include pneumothorax and pneumomediastinum and this should be excluded.