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Potential life-threatening complication of tonsillectomy: cervicofacial surgical emphysema
  1. Kirsten Shoemaker1,
  2. Christopher SG Thompson1,2,
  3. Rupali Sawant1 and
  4. Gundula Thiel1
  1. 1 Otolaryngology Department, NHS Lothian, Livingston, UK
  2. 2 Anatomy, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Christopher SG Thompson, christhompson3{at}


A 30-year-old woman presented to the accident and emergency department 3 days post-tonsillectomy with bleeding from the tonsillar fossa and left-sided facial swelling. The patient denied any dysphagia or breathing difficulties but experienced pain on neck movement. On examination, although the bleeding had stopped on reaching the emergency department, a small clot was noted in her left tonsillar fossa. A left facial/submandibular swelling was seen, which had been present since her operation and was slowly enlarging. Flexible nasendoscopy showed a mild left sided oropharyngeal swelling but was otherwise normal. She was treated initially with antibiotics and hydrogen peroxide gargles. After 24 hours of observation and a slight worsening of the swelling she underwent a CT of the neck. This showed widespread indurated subcutaneous surgical emphysema, originating from the left tonsillar bed. Following a period of observation and improvement in her symptoms, she was discharged home with safety netting.

  • ear, nose and throat/otolaryngology
  • ear, nose and throat
  • otolaryngology / ENT

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  • Patient consent for publication Obtained.

  • Contributors Case Identification: CT, RS, KS. Manuscript writing: CT, RS, KS. Image identification: KS. Manuscript editing/checking: CT, GT, RS. Manuscript submission: CT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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