A case of anesthesia mumps that required postoperative re-intubation

Abstract

We encountered a 59-year-old man who first underwent left internal carotid endarterectomy for left internal carotid artery stenosis and then presented with postoperative swelling of the bilateral salivary glands. He then developed upper airway obstruction that required emergency tracheal intubation. The most likely cause was thought to be anesthesia mumps, which involves a complex interaction of multiple factors including pneumoparotitis, venous congestion, and excess saliva secretion. Many cases of salivary gland swelling recover after follow-up observation alone if there are no inflammatory findings; however, severe complications may sometimes occur. If upper airway obstruction develops as in the present case, then emergency airway management must also be considered and conscientious observation is necessary.

Anaesthesia mumps: much to do about nothing

“…We made a clinical diagnosis on the basis of previous literature and the spontaneous 24 hours recovery, and postoperative imaging was not required. Despite the self-limited course of this condition in our patient, there have been rare instances of severe upper airway obstruction owing to postoperative parotid enlargement and the need for emergency re-intubation to alleviate respiratory deterioration 3 5 6. In our case, once diagnosed, the patient only required supportive conservative treatment with rehydration, analgesia and good oral hygiene.…”

“…Our case pertained to an otherwise healthy patient presenting with acute bilateral parotid swellings 24 hours after a vaginal hysterectomy and bilateral salpingo-oophorectomy. This procedure was performed in a slightly head down lithotomy position with the head in a neutral position, and lasted for 90 min; this is contrary to the various head and body positions and long-lasting surgeries extending for more than 2 hours cited in other spinal, vascular and plastic surgery cases 2–4…”

“…Kati et al described the first obstetric case of surgical mumps 24 hours following a caesarean section,7 and interestingly, there are at least two gynaecological case reports on this condition (both from Korea) following hysteroscopy and robotic-assisted hysterectomy, respectively 8 9. Specifically, Hamaguchi et al encountered signs of rapidly worsening dyspnea and expiratory stridor in their post-carotid endarterectomy patient with bilaterally swollen parotid glands, with radiography showing edematous changes in the pharyngeal wall, alluding to a potential allergic reaction 3. Similarly, Franco et al managed a post-neurosurgical patient who required a 28-day hospital stay due to massive facial oedema, which followed several hours after observing markedly enlarged parotid glands 5.…”

Acute transient sialadenitis – “anesthesia mumps:” Case report and review of literature

“…[ 12 ] However, there are few case reports where it has led to airway obstruction that required reintubation or tracheostomy. [ 3 4 13 ]…”

“…Very rarely, it has caused serious symptoms warranting urgent intervention. [ 3 4 ] The etiology of this condition remains elusive, but possible causes include trauma, infection, hypersensitivity reactions, dehydration, and obstruction of the glandular excretory ducts by position, calculi, or thickened secretions. [ 5 ] We report the case of a 6-year-old child who developed acute sialadenitis of the left parotid gland after upper gastrointestinal (GI) endoscopy.…”