Gul Jung, Woo Mok Byun, Hyung Jun Lim, Jong Gyun Kim, Dong Min Kwak, Deok Hee Lee, Sae Yeon Kim, Sun Ok Song, Il Sook Seo, Dae Lim Jee, Heung Dae Kim, Dae Pal Park
Yeungnam Univ J Med. 2007;24(2):344-344. Published online December 31, 2007
Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-old male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack-Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion appeared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.
Subcutaneous emphysema defines collection of air in subcutaneous spaces of body. It is usually originated from air in upper airway and lower respiratory tract such as larynx, trachea, bronchus and lungs. Air in subcutaneous spaces derives from leakage of air due to tearing or ruptures of airway structures, and also accompanies pneumothorax or pneumomediastinum and/or rib or sternal fractures or other major airway injuries. We experienced a case of subcutaneous emphysema caused by laryngeal injury without any associated airway injuries at neck from motorcycle accident, so we would report a case with the review of literatures.