Uvular Trauma after Laryngeal Mask Airway Use

Abstract

12-year-old boy presented with a sore throat and painful swallowing 2 days after receiving general anesthesia via laryngeal mask airway for the extraction of 2 molar teeth. The procedure had been uneventful, and he had been discharged after an overnight stay. At home he complained of worsening oropharyngeal pain and foreign body sensation. Physical examination revealed a swollen and hyperemic uvula that was partially covered by whitish exudate (Figure). Blood tests results were normal. Bacterial culture from a uvular swab was negative. The patient was treated with an oral analgesic and a prophylactic antibiotic, and he recovered fully within 5 days. Uvulitis is a rare condition in children, most commonly caused by bacterial or viral infections. 1 Hereditary angioedema, allergy, and inhalation of chemical irritants are less common causes. Traumatic uvulitis has been reported in adults after general anesthesia via endotracheal intubation 2 or laryngeal mask airway, 3 as well as after endoscopy. 4 The injury is likely due to compression of the uvula against the surrounding structures, leading to ischemia, inflammation, and necrosis. 2 It also may occur after aggressive oropharyngeal suctioning. 5 Sore throat is common after general anesthesia, but worsening oropharyngeal pain and foreign body sensation should raise the suspicion of uvular trauma. 6 The symptoms of traumatic uvulitis in adults are generally mild and resolve spontaneously. 3 Parenteral steroids and antibiotics are indicated in most severe cases. 2 Previous reports of traumatic uvulitis in children, different from adults, described a presentation with life-threatening uvular edema, occurring immediately after extubation, 7,8 We believe that mild traumatic uvulitis in children could be more common than reported. n

Postoperative uvular necrosis: A case series and literature review

“…Surgery has been reported in only two cases of uvular necrosis, although a patient performed a selfexcision in a third case. 7 In one case from our institution, surgery did not resolve symptoms. The data presented here suggest that uvular necrosis is self-limited and resolves with time, and that surgery is likely unnecessary.…”

“…They may be appropriate if there are signs of infection. Surgery has been reported in only two cases of uvular necrosis, although a patient performed a self‐excision in a third case . In one case from our institution, surgery did not resolve symptoms.…”

“…Uvular necrosis appears to be less common in pediatric patients, although there are several reports of uvular edema in this population. This could imply that the pediatric uvula tends more toward edema than necrosis in response to perioperative insults …”

“…This could imply that the pediatric uvula tends more toward edema than necrosis in response to perioperative insults. 7 Postoperative uvular necrosis is a clinical diagnosis that can be made upon inspection of the uvula postoperatively. It may take several days for a visible change to occur on the uvula, and patients may not have symptoms in the immediate postoperative period.…”

Odynophagia after Upper Endoscopy: Uvular Necrosis

“…A recent prospective evaluation of 809 patients found it to occur in 40% with an average duration of 16 ± 11 hours postoperative. However, a very severe or persistent sore throat is much rarer and in these cases, uvula necrosis should be part of the differential diagnosis especially with worsening oropharyngeal pain and foreign body sensation [2][3][4].…”