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Iranian Journal of Otorhinolaryngology Jan 2018Subcutaneous and mediastinal emphysema is a rare complication after tonsillectomy. This case presentation and literature review summarizes the existing literature on... (Review)
Review
INTRODUCTION
Subcutaneous and mediastinal emphysema is a rare complication after tonsillectomy. This case presentation and literature review summarizes the existing literature on this unusual complication.
MATERIALS AND METHODS
This study presents a case of a 21-year-old man who developed a cervical subcutaneous emphysema 6 days after tonsillectomy, whereby conservative treatment produced spontaneous resolution. A proper analysis of this case also required undertaking a systematic search in MEDLINE/PubMed and SCOPUS electronic databases concerning this rare complication, without language restrictions.
RESULTS
Based on our criteria, we identified 41 reports including 43 individual cases, in which patients were mostly young and equally distributed between the genders (18 males and 23 females, two unknown). The treatment was mainly conservative and consisted of observation and/or antibiotic therapy.
CONCLUSION
Subcutaneous or mediastinal emphysema is an uncommon complication after tonsillectomy. It is important that clinicians become aware of this rare complication, which requires a close monitoring of the patient.
PubMed: 29387658
DOI: No ID Found -
Therapeutic Advances in Respiratory... Oct 2016Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely reported in paediatric patients and may be accompanied by subcutaneous emphysema. It is usually... (Review)
Review
BACKGROUND
Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely reported in paediatric patients and may be accompanied by subcutaneous emphysema. It is usually benign and self-limiting, with only supportive therapy being needed, but severe cases may require invasive measures. Asthma exacerbations have classically been described as a cause of SPM. However, detailed descriptions in asthmatic children are scarce. We aimed at improving the current understanding of the features of SPM and subcutaneous emphysema, and outcomes, by means of a case report and a systematic review.
METHODS
For the systematic review a literature search was performed in PubMed to identify reported cases of SPM in asthmatic children.
RESULTS
The case a 10-year-old asthmatic girl with SPM is reported. The patient received an inhaled corticosteroid and long-acting beta2 agonist, in addition to sublingual immunotherapy (SLIT) with eventual control of asthma symptoms.
REVIEW
A total of 114 published cases were found since 1995, most of them in teenagers; no sex differences were observed. Clinical presentation was associated with an asthma exacerbation in a number of cases. Other presenting features were chest pain, dyspnoea, cough, and particularly acute swelling of the face, neck, and upper chest. Subcutaneous emphysema was present in most patients. Overall, three cases of pneumothorax and two cases of pneumorrhachis were reported. Therapy was mainly based on supportive care, rest, oxygen therapy, analgesics, steroids, and bronchodilators. All patients recovered spontaneously, in spite of a small initial increase in SPM in a few cases.
CONCLUSIONS
Early identification of patients at risk of SPM would avoid the high number of under-diagnosed cases. Patients should be treated not only with supportive therapy but also with measures to achieve control of the underlying cause (such as poorly controlled asthma).
Topics: Anti-Asthmatic Agents; Asthma; Child; Cough; Dyspnea; Female; Humans; Mediastinal Emphysema; Subcutaneous Emphysema; Treatment Outcome
PubMed: 27585598
DOI: 10.1177/1753465816657478