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Yeungnam Univ J Med > Volume 24(2); 2007 > Article
Yeungnam University Journal of Medicine 2007;24(2):344-344.
DOI:    Published online December 31, 2007.
Subcutaneous Emphysema and Inflammation of the Neck after Tracheal Puncture by an Intubating Stylet.
Gul Jung, Woo Mok Byun, Hyung Jun Lim, Jong Gyun Kim, Dong Min Kwak, Deok Hee Lee, Sae Yeon Kim, Sun Ok Song, Il Sook Seo, Dae Lim Jee, Heung Dae Kim, Dae Pal Park
1Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University Medical Center, Daegu, Korea.
2Department of Radiology, College of Medicine, Yeungnam University Medical Center, Daegu, Korea.
3Gyeongsang Hospital, Gyeongsan, Gyeongbuk, Korea.
Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-old male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack-Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion appeared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.
Key Words: Tracheal Injury, Intubation, Subcutaneous Emphysema
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