Extensive Subcutaneous Emphysema Post-Turbinate Surgery: Case Report on Mechanisms and Management.

Abstract

Subcutaneous emphysema following nasal surgery is a rare yet potentially severe complication. This case report describes a 40-year-old woman who developed extensive subcutaneous emphysema involving the face, neck, mediastinum, and thorax after uneventful turbinate cauterization and nostril reduction. The patient, with a history of prior septoplasty and rhinoplasty, presented with nasal obstruction and underwent the procedure under general anesthesia. Postoperatively, she developed progressive neck swelling, which rapidly extended to cervicofacial, mediastinal, and thoracic regions. Imaging via noncontrast computed tomography (CT) confirmed widespread air infiltration, while fiberoptic laryngoscopy and bronchoscopy ruled out aerodigestive injuries. Multidisciplinary management included mediastinal drainage, leading to dramatic symptom resolution. The mechanism likely involved inadvertent mucosal perforation during thermal ablation, creating a one-way valve effect that permitted air ingress during Valsalva maneuvers. This case underscores the anatomical continuity between cervical and mediastinal fascial planes, enabling rapid air dissemination. Key lessons include the importance of early imaging for atypical postoperative swelling, judicious use of thermal energy during turbinate procedures to minimize mucosal injury, and patient counseling to avoid forceful maneuvers post-surgery. Despite an uncomplicated intraoperative course, occult tissue defects can precipitate life-threatening complications, necessitating prompt intervention. Surgeons should maintain a high index of suspicion for subcutaneous emphysema in nasal surgeries, particularly when employing thermal techniques, and prioritize multidisciplinary collaboration to optimize outcomes. This report highlights the critical balance between procedural efficacy and safety in preventing rare but consequential complications.