Postoperative uvular necrosis: A case series and literature review

Abstract

Objectives/Hypothesis Postoperative uvular necrosis is rare, but can be distressing to the patient when it unexpectedly occurs. Little has been published regarding its predisposing factors and pathophysiology. The purpose of this comprehensive review was to compile cases of postoperative uvular necrosis and identify risk factors and potential causes for this complication. Study Design Retrospective case series. Methods The study was performed at an academic tertiary care referral center. Clinical records from four patients treated for postoperative uvular necrosis from 2008 to 2018 were reviewed. A comprehensive literature review was also performed. The MEDLINE, Embase, and Scopus databases were searched, as well as the grey literature. All case reports and literature reviews in the English literature from 1978 to 2018 were systematically identified for review. Results Four cases of postoperative uvular necrosis diagnosed clinically at our institution were included. The comprehensive literature review identified 26 reports and seven case series, totaling 53 cases of this complication. Use of suction was reported in 19 cases, and six cases reported no use of suction. Ninety‐four percent of cases were treated conservatively, whereas 6% underwent excision. Ninety‐one percent resolved within 14 days. Conclusions Impingement with various devices and vascular trauma from suction each likely play a role in postoperative uvular necrosis. Male oropharyngeal anatomy may be a risk factor, but neither the type of instrumentation nor the type of procedure seem to predict this complication. Proper positioning of the patient and instruments and minimizing suction force help prevent uvular injury. Level of Evidence NA Laryngoscope, 130:880–885, 2020

Iatrogenic uvular injury related to airway instrumentation: A report of 13 cases from the webAIRS database and a review of uvular necrosis following inadvertent uvular injury

“…3,4 Men represented three-quarters of all reported cases but there were no other associations reported with the type or length of procedure, or the type or size of oropharyngeal airway. 3 The largest study included ten patients, and reported an incidence of 0.034% over four years at a single tertiary centre. 5 It is unclear whether there are any specific preventable factors, or any specific management strategies that might reduce this complication.…”

“…endotracheal tubes (ETTs), laryngeal masks, upper gastrointestinal endoscopy, transoesophageal echocardiogram, aggressive oropharyngeal suction). 2,3 A brief literature search (including PubMed, CINAHL Complete, Embase) found a total of 53 reported cases of uvular necrosis worldwide, with the first report published in 1978. 3,4 Men represented three-quarters of all reported cases but there were no other associations reported with the type or length of procedure, or the type or size of oropharyngeal airway.…”

“…2,3 A brief literature search (including PubMed, CINAHL Complete, Embase) found a total of 53 reported cases of uvular necrosis worldwide, with the first report published in 1978. 3,4 Men represented three-quarters of all reported cases but there were no other associations reported with the type or length of procedure, or the type or size of oropharyngeal airway. 3 The largest study included ten patients, and reported an incidence of 0.034% over four years at a single tertiary centre.…”

Hair-thread Tourniquet Syndrome causing uvular strangulation in a child

“…4 Uvular necrosis is most commonly iatrogenic, following intubation, endoscopy or suction. 5 Most documented cases, predominantly in adults, resolve conservatively, with necrotic tissue sloughing off in 7-14 days. 5 Contributors Patient seen by all three authors.…”

“…5 Most documented cases, predominantly in adults, resolve conservatively, with necrotic tissue sloughing off in 7-14 days. 5 Contributors Patient seen by all three authors. JP took photographs.…”