Anesthesia mumps with airway obstruction after radical nephrectomy: A case report and literature review

Abstract

Anesthesia mumps have rarely been reported. This article presents the diagnosis and treatment of a case of anesthesia mumps with airway obstruction in the urology department and reviews previous cases of the disease. A 58-year-old man had a history of hypertension and diabetes, and his blood pressure and glucose levels were well controlled. He underwent laparoscopic radical nephrectomy for a right renal tumor. Postoperatively, a swelling of approximately 5 × 4 cm was observed in the left parotid region and left eyelid, no palpable crepitation was detected, and the skin overlying the left parotid gland was mildly hyperemic and tender. Enhanced computed tomography of the head and neck revealed obvious swelling of the laryngopharyngeal airway, and electronic laryngoscopy showed narrow airway. Laboratory test results including white blood cell count, C-reactive protein, serum amylase, and lipase levels were normal. Glycosylated hemoglobin level was 6.8%, and the salivary culture from Stensen's duct was negative. The patient was managed with endotracheal intubation and a ventilator to maintain breathing along with anti-infection, expectorant, and symptomatic treatment. The swelling in the left parotid gland gradually resolved without recurrence, and the patient was extubated on the 7th postoperative day. In this case, the pathophysiology of anesthesia mumps may have been related to the incorrect positioning of the thick short neck and the use of a head ring, which can result in the squeezing of vessels. In most cases, the salivary gland swelling resolves with observation and symptomatic treatment. In patients with anesthesia mumps, emergency airway management and careful observation are necessary if upper airway obstruction occurs. This case report should increase awareness of anesthesia mumps and its complications among anesthesiologists, surgeons, and postoperative caregivers.

Acute Post-operative Transient Sialadenitis "Anesthesia Mumps" After Caesarean Section Under Spinal Anesthesia: A Case Report

“…Anesthesia mumps is an acute postoperative unilateral or bilateral swelling of the parotid gland, first described in 1960 [ 2 , 4 ], and the reported incidence is 0.16. % to 0.2% [ 3 ]. The exact pathophysiology of anesthesia mumps is unclear, and many factors are thought to play a role (Table 2 ).…”

“…First, muscle relaxant usage in general anesthesia leads to loss of muscle tone, which may facilitate the retrograde passage of air into the parotid gland when the positive pressure intraorally is increased during induction of anesthesia, in addition to coughing and excessive straining at the emergence from general anesthesia which can cause retrograde airflow into the parotid gland [ 3 , 7 ]. Second, perioperative medications like atropine, succinylcholine, glycopyrrolate, and morphine, in addition to preoperative dehydration, can cause the retention and increased viscosity of saliva, occluding the salivary ducts [ 8 ].…”

“…Muscle relaxant usage in general anesthesia Loss of muscle tone may facilitate the retrograde passage of air into the parotid gland when the positive pressure intraorally is increased during induction of anesthesia or after coughing and excessive straining at the emergence from general anesthesia [3,7].…”

“…Extreme head rotation in a long-standing surgical procedure can impair the proper drainage of the parotid gland [3] and can potentially cause glandular ischemia by squeezing arterial or venous vessels [5].…”

“…The exact incidence is unknown, but it is reported to be 0.16. % to 0.2% [ 3 ]. It frequently starts as a painless unilateral or bilateral parotid enlargement that subsides within a few days with no long-term sequelae [ 4 ].…”