Pneumomediastinum, pneumothorax and subcutaneous emphysema after tracheostomy closure. When less is more

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Andrea Lazzarotto
Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.

Alessandro Tel
Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.

Luigi Vetrugno
Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy

Lorenzo Cereser
Institute of Radiology, Department of Medicine, University of Udine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy

Salvatore Sembronio
Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy

Michele Di Cosola
4. Department of Clinical and Experimental Medicine, Riuniti University Hospital of Foggia, Viale Luigi Pinto 1, 71122, Foggia, Italy

Tiziana Bove
2. Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy

Massimo Robiony
a:1:{s:5:"en_US";s:114:"Chief of Maxillofacial Surgery Unit, Academic Hospital of Udine Department of Medical Sciences University of Udine";}

Keywords

Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Tracheostomy

Abstract

Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on several factors, including direct trauma to the tracheal wall caused by surgical maneuvers or insufficient closure of soft tissue layers which do not seal air leakage. In this paper we explore this phenomenon by reporting the case of one patient undergoing surgical closure of tracheostomy after two weeks, who later developed subcutaneous emphysema followed by pneumomediastinum. Physiopatology is analyzed and management strategies for this condition are suggested based on our experience.

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References

1. Mickelson S, Rosenthal L. Closure of permanent tracheostomy in patients with sleep apnea: A comparison of two techniques. Otolaryngology - Head and Neck Surgery. 1997 Jan;116(1):36–40. doi: 10.1016/S0194-5998(97)70349-8
2. Lee BH, Sarah GE, Rosbe KW, Alemi S. Pneumothorax after tracheostomy closure with successful nonsurgical management. Journal of Clinical Anesthesia. 2016 Jun;31:115–8. doi: 10.1016/j.jclinane.2016.01.033
3. Fikkers BG, van Veen JA, Kooloos JG, Pickkers P, van den Hoogen FJA, Hillen B, et al. Emphysema and Pneumothorax After Percutaneous Tracheostomy. Chest. 2004 May;125(5):1805–14. doi: 10.1378/chest.125.5.1805

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Jan 19, 2022
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1.
Lazzarotto A, Tel A, Vetrugno L, Cereser L, Sembronio S, Di Cosola M, Bove T, Robiony M. Pneumomediastinum, pneumothorax and subcutaneous emphysema after tracheostomy closure. When less is more. Acta Biomed [Internet]. 2022 Jan. 19 [cited 2023 Feb. 27];92(S1):e2021368. Available from: 11551
Issue
Vol. 92 No. S1 (2021): Vol. 92 Suppl. 1 (2021): Special issue: Case Reports
Section
Case Reports: General Surgery and Miscellanea
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