An unusual, but not rare complication of lower neck surgery is pneumothorax. The association of pneumomediastinum is not coincidental, but is in most cases an integral part of the pathologic mechanism. This complication if unrecognized and untreated may be fatal.
The combination of pneumomediastinum and pneumothorax following surgery at the root of the neck was first described, in the earlier literature, as a complication of tracheostomy. In 1884, Champneys1 reported 82 cases of pneumothorax after tracheostomy, with five known cases of mediastinal emphysema.
With the advent of thyroid surgery, this complication was observed with increasing frequency by Buford2 in 1918, Keis3 in 1934, and Barrie4 in 1940.
More recently, radical neck surgery has resulted in the alertness to recognize this complication, as reported by Bowden and Schweizer5 in 1950, Aiken and Smith6 in 1952, Schweizer and Howland7 and Marchetta8 in 1956.