Gillot C, Tombu S, Crestani V, Huvelle P, Moreau P
Department of Otorhinolaryngology, CHU Liège.
B-ENT. 2005;1(4):197-200.
Subcutaneous emphysema and mediastinitis are rarely reported complications of tonsillectomy.
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.
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.
Emphysema and mediastinitis after tonsillectomy occur seldomly. If rapidly recognised and appropriately managed, mortality can be avoided.
皮下气肿和纵隔炎是扁桃体切除术后鲜有报道的并发症。
我们描述了两名扁桃体切除术后数天内发生皮下气肿的患者，其中一名并发纵隔炎。诊断基于临床表现，并经计算机断层扫描（CT）证实。对于未并发纵隔炎的患者，经短期再次插管和使用抗生素后，气肿消失。对于并发纵隔炎的患者，必须进行颈纵隔脓性积液的外科引流才能治愈。
导致皮下气肿和纵隔炎的事件尚未完全阐明。可能包括空气通过扁桃体床或插管所致的喉或咽伤口直接进入颈部。本文讨论了皮下气肿和纵隔炎的临床表现、治疗及可能的病理生理学。
扁桃体切除术后气肿和纵隔炎很少发生。如果能迅速识别并进行适当处理，可避免死亡。
