Massive pneumomediastinum with subcutaneous emphysema after elective adenotonsillectomy in children: Involvement of the Boyle-Davis mouth gag.

Adenotonsillectomy, a very common surgical procedure in otorhinolaryngology, is considered easy and safe surgery. However, clinicians should be aware of some less common but potentially life-threatening complications. This report discusses subcutaneous emphysema with pneumomediastinum following elective adenotonsillar surgery in children. The Boyle-Davis mouth gag seemed to play a part in the pathogenic mechanism of this rare complication in this case. Better insights in the mechanism of this severe complication of adenotonsillectomy may contribute to the prevention of this complication.

Wegener granulomatosis as possible cause of vertigo: case report and review.

OBJECTIVE: Wegener granulomatosis (WG) or granulomatosis with polyangiitis (GPA) is a multi-system necrotizing granulomatous vasculitis that classically affects the upper respiratory tract, lungs and kidneys. We report the unusual clinical course of a patient with WG, and we present a literature review on the association between WG and vertigo. RESULTS: In our case, a 56-year-old female presented with a several-month history of chronic sinusitis and otalgia that was refractory to all initiated outpatient therapies. During hospitalization, a diagnostic evaluation revealed serious nasal crusting, chronic otitis media, and hematuria. Serologic testing showed elevated anti-neutrophil cytoplasmic antibodies (c-ANCAs). The tentative diagnosis of Wegener granulomatosis was confirmed by renal biopsy. Upon admission, the patient developed an acute vertigo with nystagmus, nausea, and vomiting, accompanied by sensorineural hearing loss in one ear. CONCLUSIONS: Vestibular symptoms may be associated with Wegener granulomatosis.