Uvular necrosis: a rare complication of airway management

Abstract

We present the case of a 50-year-old man who developed uvular necrosis following a laparoscopic appendicectomy of 45 min duration. On the second postoperative day, he felt a painful, choking sensation, and felt his uvula `sticking´to the back of his throat, associated with `dry retching´. On examination, his uvula had a white coating on the distal aspect (Fig. 1). We diagnosed uvular necrosis, which was managed conservatively, resulting in complete resolution within a week. A literature review of 53 cases of uvular necrosis after general anaesthesia demonstrated an average procedure duration of 123 min, with a range of 15-360 min [1]. Uvular necrosis can occur with tracheal intubation or laryngeal mask use and has been found to be more common in men [1-4]. The incidence is unknown as symptoms are non-specific [4]. Patients typically report a foreign body sensation, gag reflex activation, a sore throat, and dysphagia. Clinical examination reveals ischaemic changes such as erythema, oedema, and a fibrin cap overlying a necrotic tip. The cause is thought to be physical contact between the uvula and airway devices, and vascular trauma from suctioning [1, 4]. Although initial symptoms such as sore throat are common following general anaesthesia [5], persistent or worsening symptoms should alert clinicians to the possibility of uvular necrosis. The diagnosis is important because significant complications may occur, including airway obstruction, haemorrhage, and infection [1, 3, 4]. The management of uvular necrosis is usually conservative with the aim of symptomatic relief; the necrotic segment typically auto-amputates over days to weeks [2]. Various treatments have been reported, including steroids, anti-inflammatories, antihistamines, antibiotics, and topical treatments including epinephrine and lidocaine; surgical intervention has occasionally been reported [1, 3].Figure 1 Photograph of patient's uvula, demonstrating erythema, oedema and a fibrin cap overlying a necrotic tip.