Acute unilateral swelling of parotid gland after lateral decubitus position under general anesthesia: Anesthesia Mumps

Dear Editor, Acute postoperative sialadenitis also known as “Anesthesia Mumps” is one of the uncommon complications of anesthesia. It usually resolves without any treatment, and very rarely can cause serious respiratory distress requiring urgent intervention.[1] We report a case of postoperative parotitis likely due to the obstruction of the Stensen duct caused by lateral position for a prolonged time. A 43-year-old, 70 kg hypertensive female was posted for open reduction and internal fixation for a fractured shaft of the humerus under general anesthesia. Anesthesia was induced and maintained by standard anesthesia protocol. Surgery was performed in the left lateral position. The head of the patient rested on a ring that was kept on a pillow. Hemodynamic parameters were stable throughout the surgery. Intraoperatively 3 L of fluids were administered and 370 mL of urine output was recorded. At the end of the surgery that lasted for 5 h 30 min, when the patient was turned supine swelling at the ear pinna and left cheek was noted. The anesthesia was reversed and the trachea was extubated smoothly. However, in view of the large swelling at the angle of the jaw patient was shifted to the surgical ICU for further observation and monitoring. The patient complained of pain at the site of the swelling. Ear and nose throat consultation was sought and after ultrasonography of the swelling diagnosis of parotid swelling with inflammation was confirmed [Figure 1]. Antibiotic and anti-inflammatory were started and gradually the swelling and pain subsided in 10 days.Figure 1: Swelling of Parotid gland and ear lobeAnesthesia mumps was first described by Attas et al.[2] in 1968. It usually involves the submandibular or parotid gland. This complication has been reported after general anesthesia and even after spinal anesthesia. Surgical procedures lasting more than 5 h, dehydration, mouth dryness due to anesthetic agents, straining and coughing during extubation, and mechanical obstruction of the salivary duct due to head position are the common predisposing factors for postoperative parotitis.[3] In our case, the obstruction of the Stenson’s duct in the lateral position by the head ring could be the reason as the swelling was unilateral and was associated with redness and swelling of the ear pinna. Postoperative parotitis is a painful condition that sometimes requires surgical excision of the swelling. Generally, the airway is not affected, however, there are some case reports of airway obstruction.[4] Postoperative parotitis is one of the rare complications of lateral position. However, it is a preventable condition that otherwise may cause airway obstruction. Hence, one should be very vigilant and ensure the proper position of the head and neck during the lateral position to avoid obstruction of the parotid duct, particularly in long-duration surgery. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.