Cervicofacial Subcutaneous Emphysema Following Tonsillectomy: Implications for Anesthesiologists

Cervicofacial subcutaneous emphysema is an unusual complication following tonsil- lectomy. We present a 37-year-old male patient who, after receiving tonsillectomy, developed cervicofacial subcutaneous emphysema immediately following endotracheal extubation. Valsalva maneuvers evidenced by coughing and straining of the patient, and positive pressure ventilation by mask to alleviate laryngospasm in an emergency were believed to induce and exacerbate the emphysema. Fortunately, the patient was re-intubated and protected from further complication of pneumomediastinum or pneumothorax. The emphysema resolved 7 days later with conservative treatment, including broad-spectrum antibiotics and abstention from enteral intake. This case serves as a reminder that an unusual and unexpected complication can occur in a routine procedure. Methods to prevent this complication are discussed.