DOI QR코드

DOI QR Code

수면무호흡 환자에서의 외측 인두성형술 후 발생한 피하기종

A Rare Case of Subcutaneous Emphysema following Lateral Pharyngoplasty for Obstructive Sleep Apnea

  • 차동철 (연세대학교 의과대학 이비인후과학교실) ;
  • 이영우 (연세대학교 의과대학 기도점액연구소) ;
  • 조형주 (연세대학교 의과대학 이비인후과학교실)
  • Cha, Dongchul (Department of Otorhinolaryngology, Yonsei University College of Medicine) ;
  • Lee, Young-woo (The Airway Mucus Institute, Yonsei University College of Medicine) ;
  • Cho, Hyung-Ju (Department of Otorhinolaryngology, Yonsei University College of Medicine)
  • 투고 : 2017.08.31
  • 심사 : 2018.02.01
  • 발행 : 2018.11.30

초록

Lateral pharyngoplasty is a surgical option for treatment of obstructive sleep apnea (OSA). Here, we present a case involving a 40-year-old healthy man who underwent surgery, including lateral pharyngoplasty and robotic tongue base resection, for OSA. There were no intraoperative or immediate postoperative complications. However, on postoperative day 3, the patient presented with swelling in the temporal and buccal areas and was diagnosed with subcutaneous emphysema, later confirmed by computed tomography. The patient was carefully monitored under conservative care and discharged without complications. Although subcutaneous emphysema following tonsillectomy is a rare complication and usually resolves with conservative management, in certain cases, it might require surgical intervention. Lateral pharyngoplasty involves tonsillectomy and additional incision along the tonsillar fossa, which makes it susceptible to pharyngeal wall defects and, consequently, subcutaneous emphysema. Additionally, lateral pharyngoplasty and robotic tongue base resection cause pain and might thus contribute to the increase in intrapharyngeal pressure, which might aggravate subcutaneous emphysema. Lateral pharyngoplasty should be performed with meticulous dissection of the superior pharyngeal constrictor muscle. Healthcare providers should be aware of these complications and, upon suspicion of the same, place the patient under close observation to prevent life-threatening situations.

키워드

참고문헌

  1. Fechner FP, Kieff D. Cervical emphysema complicating tonsillectomy with argon beam coagulation. Laryngoscope 2003;113:920-1. https://doi.org/10.1097/00005537-200305000-00027
  2. Kim JP, Park JJ, Kang HS, Song MS. Subcutaneous emphysema and pneumomediastinum after tonsillectomy. Am J Otolaryngol 2010;31:212-5. https://doi.org/10.1016/j.amjoto.2009.02.004
  3. Bizaki A, Kaariainen J, Harju T, Rautiainen M. Facial subcutaneous emphysema after tonsillectomy. Head Face Med 2014;10:11. https://doi.org/10.1186/1746-160X-10-11
  4. Lim HG, Jung GW, Lim JY, Choi JS. Two Cases of Cervical Emphysema after Tonsillectomy. Korean J Otolaryngol 2015;58(4):267-70.
  5. Tran DD, Littlefield PD. Late presentation of subcutaneous emphysema and pneumomediastinum following elective tonsillectomy. Am J Otolaryngol 2015;36:299-302. https://doi.org/10.1016/j.amjoto.2014.10.034
  6. Yelnoorkar S, Issing W. Cervicofacial Surgical Emphysema following Tonsillectomy. Case Rep Otolaryngol 2014;2014:746152.
  7. Yammine NV, Alherabi A, Gerin-Lajoie J. Post-tonsillectomy subcutaneous emphysema and pneumomediastinum. J Otolaryngol 2004;33:403-4. https://doi.org/10.2310/7070.2004.04061
  8. El-Chazali AM. Spontaneous emphysema of the neck. J Laryngol Otol 1983;97:383-6. https://doi.org/10.1017/S0022215100094287
  9. Hampton SM, Cinnamond MJ. Subcutaneous emphysema as a complication of tonsillectomy. J Laryngol Otol 1997;111:1077-8. https://doi.org/10.1017/S0022215100139398
  10. Vos GD, Marres EH, Heineman E, Janssens M. Tension pneumoperitoneum as an early complication after adenotonsillectomy. J Laryngol Otol 1995;109:440-1. https://doi.org/10.1017/S0022215100130385
  11. Ferguson CC, McGarry PM, Beckman IH, Broder M. Surgical emphysema complicating tonsillectomy and dental extraction. Can Med Assoc J 1955;72:847-8.