Subcutaneous emphysema is a rare but potentially-serious complication of tonsillectomy. This case report presents a 14-year-old male who developed subcutaneous emphysema following tonsillectomy. A comprehensive literature review was conducted to identify and analyze cases of emphysema following tonsillectomy. The review revealed a diverse range of clinical presentations, from mild neck swelling to severe respiratory distress. Most cases resolved spontaneously with conservative management, but a small subset required surgical intervention. Early recognition, prompt evaluation, and appropriate management are essential to prevent complications and ensure favorable outcomes. This case highlights the importance of considering subcutaneous emphysema as a differential diagnosis in patients presenting with neck swelling or respiratory symptoms following tonsillectomy.