Abstract The fact that mediastinal emphysema has only latterly been given serious attention as a complication of tracheotomy does not imply that it is rare but that its diagnosis presents difficulty (Michels, 1939). This author pointed out, as did Neffson (1943), Macklin and Macklin (1944), Stothers (1956), and Nicholas (1958), that mediastinal emphysema is far commoner than is suggested by the literature. Stothers and Nicholas have both studied the pathogenesis and clinical features of the disorder and given detailed reviews of the earlier literature in the sphere. It now seems practically certain that the chief cause of this complication is the increase in negative intrathoracic pressure brought about by respiratory obstruction which results in the intake of air at the tracheotomy procedure itself. The most critical step in the operation is the incision of the pretracheal fascia, since air appears most readily to be drawn in between this fascial plane and References 1. Forbes, G. B.; Salmon, G., and Herweg, J. C.: Further Observations on Post-Tracheotomy, Mediastinal Emphysema, and Pneumothorax , J. Pediat. 31:172, 1947.Crossref 2. Goldberg, J. D.; Mitchell, N., and Angrist, A.: Mediastinal Emphysema and Pneumothorax Following Tracheotomy for Croup , Am. J. Surg. 56:448, 1942.Crossref 3. Macklin, M. T., and Macklin, C. C.: Malignant Interstitial Emphysema of the Lungs and Mediastinum as an Important Occult Complication in Many Respiratory Diseases and Other Conditions: An Interpretation of the Clinical Literature in the Light of Laboratory Experiment , Medicine 23:281, 1944.Crossref 4. Michels, M. W.: Pneumothorax and Mediastinal Emphysema Complicating Tracheotomy , Arch. Otolaryng. 29:842, 1939.Crossref 5. Mårtensson, B., and Nilsson, G.: Corticosteroider vid pseudokrupp , Svens. läk.-tidningen 55:1525, 1958. 6. Neffson, A. H.: Tension Pneumothorax and Mediastinal Emphysema After Tracheotomy , Arch. Otolaryng. 37:23, 1943.Crossref 7. Acute Laryngotracheobronchitis , New York, Gruen & Stratton, Inc., 1949. 8. Nicholas, J. N.: Mediastinal Emphysema , Brit. J. Anaesth. 30:63, 1958.Crossref 9. Stothers, H. H.: Mediastinal Emphysema Complicating Tracheotomy and Thyroidectomy , Laryngoscope 66:1411, 1956.Crossref
A.M.A. Archives of Otolaryngology – American Medical Association
Published: Apr 1, 1960
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