Subcutaneous emphysema and mediastinitis: unusual complications of tonsillectomy.
BACKGROUND
Subcutaneous emphysema and mediastinitis are rarely reported complications of tonsillectomy.


METHODS
We describe two patients who developed subcutaneous emphysema, one of them with mediastinitis, within a few days after tonsillectomy. The diagnosis was based on the clinical presentation and confirmed by computed tomography (CT). For the patient without mediastinitis, the emphysema disappeared after a short period of reintubation and administration of antibiotics. For the patient with mediastinitis, surgical drainage of a cervico-mediastinal purulent collection was necessary to obtain healing.


CONCLUSIONS
The events leading to subcutaneous emphysema and mediastinitis have not been entirely clarified. They probably include direct introduction of air into the neck via either the tonsillar bed or a laryngeal or pharyngeal wound caused by intubation. The clinical presentation, treatment and possible pathophysiology of subcutaneous emphysema and medisastinits are discussed.


CONCLUSIONS
Emphysema and mediastinitis after tonsillectomy occur seldomly. If rapidly recognised and appropriately managed, mortality can be avoided.
Gillot
C
C
Department of Otorhinolaryngology, CHU Liège.
Tombu
S
S
Crestani
V
V
Huvelle
P
P
Moreau
P
P
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D014069:Tonsillitis / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents