POSTOPERATIVE CERVICOFACIAL SUBCUTANEOUS EMPHYSEMA FOLLOWING COMBINED TONSILLECTOMY AND TRANSORAL STYLOIDECTOMY IN A PATIENT WITH EAGLE SYNDROME: A RARE CASE REPORT

Eagle syndrome is an uncommon condition caused by elongation of the styloid process or ossification of the stylohyoid ligament and may present with cervicofacial or pharyngeal pain, dysphagia, and otalgia. Surgical treatment is effective; however, complications following transoral styloidectomy are uncommon. We report a rare case of cervicofacial subcutaneous emphysema following bilateral tonsillectomy and transoral styloidectomy. A 52-year-old woman presented with a one-year history of right-sided neck pain radiating to the ear and aggravated by swallowing. Examination and computed tomography demonstrated an elongated right styloid process measuring approximately 3.5 cm. She underwent bilateral tonsillectomy followed by right-sided transoral styloidectomy, with approximately 1.5 cm of the distal styloid process excised. Approximately 30 minutes after surgery, she developed sudden cervicofacial swelling with crepitus. There was no airway obstruction or respiratory compromise, and oxygen saturation remained 98% on room air. Imaging was not performed because she remained clinically stable without respiratory or thoracic symptoms. She was managed conservatively with airway and cardiorespiratory observation, intravenous fluids, ceftriaxone, and restriction of oral intake. The emphysema resolved, and she was discharged after seven days. At one-month follow-up, her neck pain and otalgia had completely resolved. Deep dissection required for transoral styloid exposure may have contributed to disruption of tissue planes and facilitated air entry, although a definitive causal mechanism could not be established. This case highlights cervicofacial subcutaneous emphysema as a rare complication of combined tonsillectomy and transoral styloidectomy and emphasizes early recognition, airway and thoracic assessment, meticulous surgical technique, and conservative management in stable patients.