Uvular necrosis in an adolescent following general anaesthesia in the prone position

Abstract

Uvular necrosis is a rare but potentially life-threatening complication of general anaesthesia involving endotracheal intubation. The proposed mechanism is mechanical disruption of uvular blood supply resulting in ischaemia and subsequent necrosis. This is typically a consequence of impingement of the uvula against a midline tracheal tube and the hard palate. Vigorous suctioning, multiple pharyngeal tubes and patient positioning have also been implicated. We present the case of a 13-yr-old girl who suffered uvular necrosis following a procedure performed in the prone position. The patient was reassured and managed conservatively. As in previous cases, after two weeks she made a full recovery following separation of the necrosed portion of her uvula. In the paediatric population, due to the relatively smaller oropharyngeal space, particular vigilance should be maintained during airway instrumentation, patient positioning, and placement of pharyngeal tubes in order to minimise the risk of uvular trauma.

A postoperative woman with sore throat

“…Uvular necrosis is an uncommon adverse event resulting from impingement by airway devices or vigorous suctioning during surgical procedures 1,2 . Patients may experience sore throat, foreign body sensation, coughing, and, in severe cases, infection or airway obstruction 3,4 . Uvular necrosis is a clinical diagnosis, often made with direct observation of an elongated, inflamed uvula with white exudates at the necrotic tip 5 .…”

“…Uvular necrosis is a clinical diagnosis, often made with direct observation of an elongated, inflamed uvula with white exudates at the necrotic tip 5 . Treatment course is usually conservative with antibiotics, corticosteroids, topical anesthetics, and nebulized epinephrine with sloughing of the necrotic tissue within 2 weeks 3 . Rarely, severe cases require excision of the necrotic tissue 6 …”

“…1,2 Patients may experience sore throat, foreign body sensation, coughing, and, in severe cases, infection or airway obstruction. 3,4 Uvular necrosis is a clinical diagnosis, often made with direct observation of an elongated, inflamed uvula with white exudates at the necrotic tip. 5 Treatment course is usually conservative with antibiotics, corticosteroids, topical anesthetics, and nebulized epinephrine with sloughing of the necrotic tissue within 2 weeks.…”

“…5 Treatment course is usually conservative with antibiotics, corticosteroids, topical anesthetics, and nebulized epinephrine with sloughing of the necrotic tissue within 2 weeks. 3 Rarely, severe cases require excision of the necrotic tissue. 6 Ear, nose, and throat (ENT) surgeons were consulted and recommended conservative management with a 7-day course of amoxicillinclavulanic acid and nystatin mouthwash.…”