Authors: Kurosawa Y et al.
Cureus 17(10): e95653, October 2025. DOI: 10.7759/cureus.95653
This case report describes a 74-year-old woman who developed right cervical subcutaneous emphysema and pneumomediastinum during anesthesia induction for oral surgery under general anesthesia, secondary to nasopharyngeal wall injury during nasotracheal intubation (NTI). Despite stable oxygenation and hemodynamics, postoperative imaging confirmed the presence of free air extending from the retropharyngeal space to the mediastinum. Conservative treatment with antibiotics, high-flow oxygen, and rest led to full recovery by postoperative day five.
Repeated intubation attempts and the use of an inappropriately large tube were considered the primary contributors to mucosal trauma. The authors emphasize careful tube size selection, lubrication, avoidance of repeated blind attempts, and early conversion to orotracheal intubation if resistance is encountered. Postoperative monitoring and prompt imaging are critical for early detection and management of these potentially life-threatening complications.
What You Should Know
Nasotracheal intubation, though common in oral and maxillofacial surgery, can lead to rare but serious complications like subcutaneous emphysema and pneumomediastinum if pharyngeal injury occurs. Prevention hinges on proper technique, minimizing resistance, and maintaining readiness to switch airway strategies when needed.
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