Airway obstruction caused by massive postoperative sialadenitis

Introduction Sialadenitis following neurosurgical operation is a rare, mostly positional-related complication, which can be life-threatening without adequate therapy.

Case We were consulted to a 28-year-old patient having a progressive, painless swelling of the left neck, following neurosurgical resection of a pineal tumor in an adequate park bench position. The computed tomography scan of the neck revealed swollen left submandibular and parotid glands with surrounding fluid accumulation that expanded along the cervical nerve sheath down to the upper thorax. After initiation of intravenous hydration and use of sialagogues, the swelling progressed rapidly within a few hours. Despite high-dose intravenous glucocorticoids and antibiotics, the patient had to be intubated one day later due to a severely edematous supraglottic larynx. The ducts of the glands were sounded and dilated daily. As the therapy was successful, the patient was extubated two days later.

Conclusion It is hypothesized that postoperative sialadenitis may be caused by the combination of intraoperative dehydration, anatomic predisposition and head inclination and rotation needed for the parkbench position. This can result in compression of the cervical salivary glands and consecutive stasis in the salivary duct. An immediate therapy with volume substitution, sialagogues, antibiotic prophylaxis, glucocorticoids and airway management is essential to provide further expansion. Complications of cervical swelling might be airway compression or even entrapment of the brachial plexus or the caudal cranial nerves.

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Publication History

Article published online:
13 May 2021