Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients - A case report -

Abstract

Peripheral nerve damage associated with patient positioning occurs not infrequently. However, quadriplegia following non-spinal surgeries is a rare complication. Several reports claim injury resulting from hyperextension of the cervical spine. Most of these cases were related to pre-existing cervical spondylosis and cervical spinal stenosis, in which the spinal cord was vulnerable to damage caused by prolonged neck extension. Compression of the cervical spinal cord can lead to sequelae such as diminished fine motor skills of the hand or balance difficulties, or incontinence and complete paralysis in severe cases. We present a case of quadriplegia caused by prolonged neck hyperextension during the performance of parotidectomy and discuss reasons for cervical cord injury in similar cases. During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department. CASE REPoRT