Skull Base 2008; 18(2): 129-134
DOI: 10.1055/s-2007-991110
CASE REPORT

© Thieme Medical Publishers

Postoperative Acute Sialadenitis after Skull Base Surgery

Louis J. Kim1 , Jeffrey D. Klopfenstein1 , Iman Feiz-Erfan1 , Geoffrey P. Zubay2 , Robert F. Spetzler1
  • 1Barrow Neurological Institute, Phoenix, Arizona
  • 2Private Practice, Del Mar, California
Further Information

Publication History

Publication Date:
04 January 2008 (online)

ABSTRACT

During retrosigmoid and far-lateral skull base surgical approaches, the head may be positioned at the extreme limits of rotation and flexion. In rare instances, patients may develop acute sialadenitis after surgery as a result of this positioning technique. Over a 4-year period, five patients developed postoperative sialadenitis after undergoing either a retrosigmoid craniotomy in the supine position (n = 4) or a far-lateral craniotomy in the park-bench position. Based on all the retrosigmoid and far-lateral approaches performed by the senior author (RFS), the incidence of sialadenitis was 0.84%. In all five patients, the acute sialadenitis was not clinically apparent at the conclusion of the operation. However, the diagnosis was evident within 4 hours of surgery. In each case, the neck swelling in the vicinity of the submandibular gland was contralateral to the craniotomy site. All patients were treated with intravenous hydration and antibiotic therapy. One patient was extubated immediately after surgery with no obvious evidence of sialadenitis. However, she required emergent reintubation due to airway compromise. The mechanism of acute sialadenitis in these patients was obstruction of the salivary duct caused by surgical positioning. This previously unreported observation in patients undergoing skull base surgery deserves consideration during perioperative and postoperative management.

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Robert F SpetzlerM.D. 

c/o Neuroscience Publications, Barrow Neurological Institute

350 W. Thomas Road, Phoenix, AZ 85013

Email: neuropub@chw.edu