title: Early Postoperative Malignant Subcutaneous Emphysema: Report and Review.
abstract: BACKGROUND
  Subcutaneous emphysema is defined as presence of air or gas in subcutaneous tissue layer. It may be localized or generalized due to various aetiological factors. Although SE and pneumomediastinum are self-limiting conditions, life-threatening complications may develop. Escape of air into both pleural cavity causing bilateral pneumothorax and tension pneumothorax can be termed as malignant emphysema.
  
  
  OBJECTIVE
  To report a case of malignant generalized subcutaneous emphysema in early postoperative phase following palatoplasty.
  
  
  METHODS
  A 25 year old female patient was operated for closure of residual oronasal communication using an anteriorly based tongue flap. The patient was reversed from general anesthesia and shifted to the post-operative room with the endotracheal tube in situ. Sudden swelling of the face and periorbital area was noticed which spread all over the body. A diagnosis of malignant post-operative subcutaneous emphysema was made and the patient was shifted back to the operation theatre. She was managed successfully by bilateral tube thoracotomy and tracheostomy.
  
  
  CONCLUSIONS
  Close observation of the patient in early postoperative stage having endotracheal tube in situ is crucial to avoid such complication. Regardless of aetiology, early recognition of the clinical features of tension pneumothorax and timely intervention are necessary for the survival of the patient.
authors.affiliation: Department of Oral and Maxillofacial Surgery, CMDC (WC), Chandimandir, Haryana 134107 India.
authors.forename: N K
authors.initials: NK
authors.lastname: Sahoo
authors.affiliation: Department of Anaesthesiology and Critical Care, CH (WC), Chandimandir, Haryana 134107 India.
authors.forename: Shivinder
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Oral and Maxillofacial Surgery, CMDC (SC), Pune, 411040 India.
authors.forename: I D
authors.initials: ID
authors.lastname: Roy
authors.affiliation: Department of Dental Surgery, Armed Forces Medical College, Pune, Maharashtra 411040 India.
authors.forename: Amit
authors.initials: A
authors.lastname: Bhandari
keywords: Subcutaneous emphysema; Tension pneumothorax; Tracheostomy