J Rhinol.  2018 Nov;25(2):99-102. 10.18787/jr.2018.25.2.99.

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

• Cha D
• Lee YW
• Cho HJ

• KMID: 2431223
• DOI: http://doi.org/10.18787/jr.2018.25.2.99

Abstract

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.

Keyword

Lateral pharyngoplasty; Sleep apnea; Subcutaneous; Emphysema; Complication

MeSH Terms

Adult
Emphysema
Health Personnel
Humans
Sleep Apnea Syndromes
Sleep Apnea, Obstructive*
Subcutaneous Emphysema*
Tongue
Tonsillectomy

Figure

• 

  Fig. 1 Intraoperative photographs of the palatal region and tongue base immediately after lateral pharyngoplasty followed by transoral robotic tongue base resection (No photographs were acquired during lateral pharyngoplasty).

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  Fig. 2 Coronal (A) and axial (B) neck computed tomography images acquired on postoperative day 4 demonstrating subcutaneous emphysema. Soft-tissue emphysema is noted in the right temporal (straight arrow) and masticator (dotted arrow) areas and bilateral neck (curved arrow).

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  Fig. 3 Facial photographs acquired on postoperative days 4 (A) and 12 (B). (A) Swelling in the right temporal and masticator areas and bilateral neck (arrow). Crepitus was also noted at these regions. (B) Subcutaneous emphysema was resolved on day 12.

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