Marked Swelling of the Submandibular Gland Developing Upper Airway Obstruction after General Anesthesia

Abstract

  Acute parotid gland swelling is a rare complication of general anesthesia and has been called ‘anesthesia mumps’. However, there have been no reports of the severe swelling of the submandibular gland after general anesthesia.
  A 67-year-old female underwent resection of brain tumor under general anesthesia with sevoflurane and remifentanil. Surgery was performed in the supine position and lasted over 10 hours. Emergence from anesthesia and extubation were uneventful. Two hours after surgery, right mandibular swelling appeared and she progressively deteriorated. Four hours after surgery, she complained of dyspnea and a cricothyrotomy using Minitrack^® was performed to avoid complete upper airway obstruction.
  Computed tomography scan revealed a low-density area from right side of the glottis to the right side of the pharynx, neck and oropharynx. On the first postoperative day, she underwent a tracheotomy because the airway obstruction caused by the neck swelling had not improved. On the second postoperative day, her neck swelling gradually reduced. The rest of the postoperative course was uneventful.
  Prolonged intubation and stimulation by intubation or extubation can account for the swelling of the tongue and pharynx that leads to right submandibular duct obstruction.