Massive facial edema and airway obstruction secondary to acute postoperative sialadenitis or “anesthesia mumps”: a case report
Massive facial edema and airway obstruction secondary to acute postoperative sialadenitis or “anesthesia mumps”: a case report
Journal of Medical Case Reports 2009, 3:7073
Published: August 2009
Published: August 2009
Introduction: A case of massive facial edema and airway obstruction secondary to an acute sialadenitis is described that occurred a few hours after a neurosurgical procedure performed in the prone position. Literature on this topic is reviewed.
Case presentation: A 73-year-old Caucasian woman underwent a right parieto-occipital craniotomy to remove a meningioma. The procedure was performed in the prone position and lasted for 7 hours. One hour after the end of surgery, left submandibular gland swelling was clearly visible and in a few hours, she developed massive facial edema. Imaging (computed tomography and magnetic resonance) showed inflammatory swelling of the submandibular and parotid glands and of the periglandular tissues, undilated excretory ducts, and complete obliteration of the pharynx lumen (pharyngeal mucosa adhered to the endotracheal tube). Analgesics, corticosteroids, and antibiotics were administered. Edema regressed from the 4th postoperative day and the endotracheal tube could be removed on the 7th postoperative day. The patient was discharged from the surgical intensive careunit on the 14th postoperative day and from hospital on the 28th postoperative day.
Conclusion: This is the first case report in which acute postoperative sialadenitis caused complete upper airway obstruction: only the presence of a tracheal tube avoided the need for an emergency tracheostomy. Since edema evolves insidiously, we recommend caution when removing the endotracheal tube in patients who are acutely developing postoperative sialadenitis.
Introduction
Acute postoperative sialadenitis, commonly known as ‘anesthesia mumps’, is occasionally observed after general anesthesia 1–4. Parotid or submandibular swelling develops during surgery or, more often, a few hours later and usually resolves in a few days with no sequelae. The etiology has not been fully explained, but possible causes include trauma, infection, hypersensitivity reactions, andobstruction of the glandular excretory ducts by position, calculi, or thickened secretion. Anesthesia mumps are usually regarded as a mild and transitory complication. Patients may complain of light pain and distress, but airway patency is not threatened, nor are reflexes such asswallowing or coughing impaired. Only in one case report did acute salivary gland swelling during anesthesia induction lead to airway obstruction and tracheostomy 5. We report a life-threatening postoperative sialadenitis that involved the left submandibular and parotid glands and caused massive facial edema and complete airway obstruction. Due to the severity of the complication, complete imaging was obtained.
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