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<article article-type="Original Article" dtd-version="1.0" xml:lang="ko" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">jr</journal-id>
<journal-title-group>
<journal-title>Journal of Rhinology</journal-title>
<abbrev-journal-title>J Rhinol</abbrev-journal-title>
</journal-title-group>
<issn pub-type="ppub">1229-1498</issn>
<issn pub-type="epub">2384-4361</issn>
<publisher>
<publisher-name>Journal of Rhinology</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.18787/jr.2018.25.2.99</article-id>
<article-id pub-id-type="publisher-id">jr-25-99</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>CASE REPORT</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>A Rare Case of Subcutaneous Emphysema following Lateral Pharyngoplasty for Obstructive Sleep Apnea</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name name-style="western" xml:lang="en"><surname>Cha</surname><given-names>Dongchul</given-names></name><degrees>MD</degrees>
<xref ref-type="aff" rid="aff1-jr-25-99"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name name-style="western" xml:lang="en"><surname>Lee</surname><given-names>Young-woo</given-names></name><degrees>MD</degrees>
<xref ref-type="aff" rid="aff2-jr-25-99"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name name-style="western" xml:lang="en"><surname>Cho</surname><given-names>Hyung-Ju</given-names></name><degrees>MD, PhD</degrees>
<xref ref-type="aff" rid="aff1-jr-25-99"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2-jr-25-99"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c1-jr-25-99"/>
</contrib>
<aff id="aff1-jr-25-99" xml:lang="en"><label>1</label>Department of Otorhinolaryngology, Seoul, <country>Korea</country></aff>
<aff id="aff2-jr-25-99" xml:lang="en"><label>2</label>The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, <country>Korea</country></aff>
</contrib-group>
<author-notes>
<corresp id="c1-jr-25-99">&#xAD50;&#xC2E0;&#xC800;&#xC790;&#xFF1A;&#xC870;&#xD615;&#xC8FC;, 03722 &#xC11C;&#xC6B8; &#xC11C;&#xB300;&#xBB38;&#xAD6C; &#xC5F0;&#xC138;&#xB85C; 50 &#xC5F0;&#xC138;&#xB300;&#xD559;&#xAD50; &#xC758;&#xACFC;&#xB300;&#xD559; &#xC774;&#xBE44;&#xC778;&#xD6C4;&#xACFC;&#xD559;&#xAD50;&#xC2E4; Tel: +82-2-2228-3605, Fax: +82-2-393-0580, E-mail: <email>hyungjucho@yuhs.ac</email></corresp>
</author-notes>
<pub-date pub-type="ppub"><month>01</month><year>2018</year></pub-date>
<pub-date pub-type="epub"><day>19</day><month>01</month><year>2018</year></pub-date>
<volume>25</volume><issue>2</issue><fpage>99</fpage>
<lpage>102</lpage>
<history>
<date date-type="received"><day>31</day><month>08</month><year>2017</year></date>
<date date-type="rev-recd"><day>11</day><month>11</month><year>2017</year></date>
<date date-type="accepted"><day>01</day><month>02</month><year>2018</year></date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2018 Journal of Rhinology</copyright-statement>
<copyright-year>2018</copyright-year>
<license><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0">http://creativecommons.org/licenses/by-nc/3.0</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license>
</permissions>
<abstract xml:lang="en">
<p>Lateral pharyngoplasty is a surgical option for treatment of obstructive sleep apnea (OSA). Here, we present a case involving a 40-year-old healthy man who underwent surgery, including lateral pharyngoplasty and robotic tongue base resection, for OSA. There were no intraoperative or immediate postoperative complications. However, on postoperative day 3, the patient presented with swelling in the temporal and buccal areas and was diagnosed with subcutaneous emphysema, later confirmed by computed tomography. The patient was carefully monitored under conservative care and discharged without complications. Although subcutaneous emphysema following tonsillectomy is a rare complication and usually resolves with conservative management, in certain cases, it might require surgical intervention. Lateral pharyngoplasty involves tonsillectomy and additional incision along the tonsillar fossa, which makes it susceptible to pharyngeal wall defects and, consequently, subcutaneous emphysema. Additionally, lateral pharyngoplasty and robotic tongue base resection cause pain and might thus contribute to the increase in intrapharyngeal pressure, which might aggravate subcutaneous emphysema. Lateral pharyngoplasty should be performed with meticulous dissection of the superior pharyngeal constrictor muscle. Healthcare providers should be aware of these complications and, upon suspicion of the same, place the patient under close observation to prevent life-threatening situations.</p>
</abstract>
<kwd-group xml:lang="en">
<kwd>Lateral pharyngoplasty</kwd>
<kwd>Sleep apnea</kwd>
<kwd>Subcutaneous</kwd>
<kwd>Emphysema</kwd>
<kwd>Complication</kwd>
</kwd-group>
</article-meta>
</front>
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<sec sec-type="display-objects">
<title>Figures</title>
<fig id="f1-jr-25-99" position="float">
<label>Fig. 1</label>
<caption xml:lang="en"><p>Intraoperative photographs of the palatal region and tongue base immediately after lateral pharyngoplasty followed by transoral robotic tongue base resection (No photographs were acquired during lateral pharyngoplasty).</p></caption>
<graphic xlink:href="jr-25-99f1.tif"/>
</fig>
<fig id="f2-jr-25-99" position="float">
<label>Fig. 2</label>
<caption xml:lang="en"><p>Coronal (A) and axial (B) neck computed tomography images acquired on postoperative day 4 demonstrating subcutaneous emphysema. Soft-tissue emphysema is noted in the right temporal (straight arrow) and masticator (dotted arrow) areas and bilateral neck (curved arrow).</p></caption>
<graphic xlink:href="jr-25-99f2.tif"/>
</fig>
<fig id="f3-jr-25-99" position="float">
<label>Fig. 3</label>
<caption xml:lang="en"><p>Facial photographs acquired on postoperative days 4 (A) and 12 (B). (A) Swelling in the right temporal and masticator areas and bilateral neck (arrow). Crepitus was also noted at these regions. (B) Subcutaneous emphysema was resolved on day 12.</p></caption>
<graphic xlink:href="jr-25-99f3.tif"/>
</fig>
</sec>
</back>
</article>