Pathogenesis of Mediastinal Emphysema and Pneumothorax following Tracheotomy

An unusual complication following tracheoesophageal puncture for alaryngeal voice restoration

“…Injury to the dome of the pleura during the creation of the T-E fistula. However, we do not believe that this could provide an explanation, especially as the mediastinal emphysema appeared on chest X-ray before the pneumothorax was demonstrated (Padovan et al, 1974). B.…”

“…The air may also dissect to the periphery of the lung and form a subpleural or true bleb, which may rupture at a later time. D. Padovan et al (1974) proposed that the mediastinal pleura in the region of the hilum is under mechanical tension due to its connection to the diaphragm through the bronchopericardial membrane inferiorly and through the tracheobronchial tree connected to the hyoid bone superiorly. With maximal extension of the tracheobronchial tree (retroflexion of head) the mediastinum becomes relatively rigid.…”

Pneumothorax and extensive subcutaneous emphysema in a French bulldog, following removal of a silicone tracheal stoma stent used for a temporary tracheostomy

“…In this study, accurate description and discussion of this complication is lacking but it seemed to be associated to postoperative tracheostomy tube dislodgement. In the human medicine literature, emphysema, pneumomediastinum and pneumothorax are well recognised complications following tracheotomy and temporary tracheostomy and are reported to be as frequent as 17%, with these complications being higher in children compared to adults 10 . Thoracic radiographs are controversially used as a screening tool for pneumomediastinum and pneumothorax following tracheostomy tube placement in people, 22–25 with pneumothorax being reported as a complication in 2% of patients 23…”

“…The mechanism of the development of pneumothorax following tracheal surgery involves the entry of air through the cervical incision and its caudal passage peritracheally into the mediastinum during inspiration, presumably due to the drop in pressure in the pleural space that accompanies inspiration 10 . When the pressure increases within the mediastinum, diffusion of this air through the mediastinum into both pleural spaces is possible with resultant pneumothorax 10,26 . Padovan et al 10 .…”

“…Emphysema, pneumomediastinum and pneumothorax following tracheostomy are recognised complications following tracheostomy in human 10 and veterinary medicine 8,9 . The authors of this report believe that a specific description of these complications is lacking in veterinary literature.…”