Surgical procedures about the neck which allow ample opportunity for partial blocking of the upper respiratory passages and for opening the mediastinum provide a situation most favorable for the development of mediastinal emphysema. Berry1 reported 4 cases of thyroidectomy and 1 of tracheotomy in which mediastinal emphysema and bilateral pneumothorax were present at death, which occurred either on the operating table or shortly afterward. At autopsy, in every case, the pleura was intact, and there was no interstitial emphysema present; air, then, must have entered through the operative site. Keis2 reported 8 cases of thyroidectomy, in 5 of which mediastinal emphysema was observed at autopsy. In 4, bilateral pneumothorax was present. In all of these cases, the tracheal and bronchial passageways were normal, and the lungs showed no interstitial emphysema.
Keis expressed the opinion that mediastinal emphysema occurring during operations on the upper portion of the neck is