title: Subcutaneous emphysema after tonsillectomy: case report.
abstract: OBJECTIVE
  Tonsillectomy is considered a relatively safe procedure. This report aimed at describing an uncommon complication of this surgical procedure: subcutaneous emphysema.
  
  
  METHODS
  Male patient, 25 years old, admitted for recurrent tonsillitis and hypertrophic nasal turbinates. Tonsillectomy and nasal cauterization were performed under general anesthesia with tracheal intubation. Surgery was uneventful. At post-anesthetic recovery unit (PACU), patient was agitated and performing major physical effort. Four hours after surgery, gross and crepitus swelling of neck and left parotid region, typical of subcutaneous emphysema, was noted. CT scan has revealed free air in the malar and cervical regions (especially to the left), reaching upper mediastinum. There was no airway obstruction and his general condition was stable. Patient was discharged one day after and was followed on ambulatory basis. Emphysema was no longer clinically evident 10 days after.
  
  
  CONCLUSIONS
  Subcutaneous emphysema is an uncommon complication of tonsillectomy, appearing almost ever after deeper dissections of the pharyngeal mucosa, when a porous surface is created, thus providing a route for the entry of air. Increased upper airway pressure may contribute to this injury.
authors.affiliation: CET, SBA, Hospital Vera Cruz, Campinas, SP. walterluizferreira@terra.com.br
authors.forename: Walter Luiz Ferreira
authors.initials: WL
authors.lastname: Lima
authors.forename: Nivaldo Simões
authors.initials: NS
authors.lastname: Correa
authors.forename: José Luiz
authors.initials: JL
authors.lastname: de Campos
authors.forename: Paulo Moraes
authors.initials: PM
authors.lastname: Navarro
authors.forename: Luciano de Oliveira
authors.initials: Lde O
authors.lastname: Correia