Subcutaneous Emphysema and Pneumomediastinum Triggered by Nasotracheal Intubation: A Case Report

Nasotracheal intubation (NTI) is frequently chosen in oral and maxillofacial surgery to provide unobstructive access to the surgical field. Despite being rare, subcutaneous emphysema (SE) and pneumomediastinum (PM) caused by nasopharyngeal wall injury are serious complications. In this report, we present the case of a 74-year-old woman who developed right cervical SE and PM during anesthesia induction for oral surgery under general anesthesia associated with nasopharyngeal wall injury due to NTI. She had no remarkable medical history or abnormal preoperative findings. During intubation, swelling and crepitus of the right neck were observed; postoperative imaging confirmed extensive SE and PM. Conservative management with antibiotics was initiated immediately post-surgery, leading to the gradual resolution of symptoms. The patient was discharged on postoperative day 5. Although SE and PM secondary to pharyngeal trauma during tracheal intubation under general anesthesia are rare, careful selection of the airway management method, along with appropriate postoperative monitoring and early intervention, is essential in oral and maxillofacial surgery.