|Year : 2014 | Volume
| Issue : 3 | Page : 183-185
Surendra Sharma, Gurjit Singh, Somnath Gooptu, Iqbal Ali
Department of General Surgery, Padmashree Dr. Dnyandeo Yashwantrao Patil Medical College, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||8-Dec-2014|
Dr. Somnath Gooptu
Department of General Surgery, Padmashree Dr. Dnyandeo Yashwantrao Patil Medical College, Pimpri, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
Swelling of parotid glands following surgeries undertaken under general anaesthesia are rare. These are termed as anaesthesia mumps or acute postoperative sialadenitis. It may be unilateral or bilateral. It may present immediately or over a variable period. It resolves spontaneously over a period of hours and days. An eight-year old child developed swelling of left parotid gland. The swelling occurred on the first postoperative day, following cholecystectomy for cholelithiasis under general anaesthesia. Induction and course of general anaesthesia was smooth. It was treated symptomatically. Swelling subsided after three days without instituting any specific therapy. Oral hygiene care was maintained with chlorhexidine mouth wash. The aim of this case report is to draw attention of the surgical fraternity to this condition which may be encountered in the immediate postoperative period and raises alarm but does not merit any aggressive management. It resolves spontaneously with symptomatic care.
Keywords: Anaesthesia, parotid swelling, post operative sialoadenitis
|How to cite this article:|
Sharma S, Singh G, Gooptu S, Ali I. Anaesthesia mumps. Arch Int Surg 2014;4:183-5
| Introduction|| |
Swelling of parotid glands after surgeries undertaken under general anesthesia are rare. These are termed as anesthesia mumps or acute postoperative sialadenitis.  Its incidence is reported as 3 in 1500,  whereas, in another study among patients undergoing endotracheal anesthesia is 5 in 3000.  It may be unilateral or bilateral. It may present immediately or over a variable period. It usually resolves spontaneously over a period of hours and days. However, rarely surgical incision may be required if there is evidence of abscess formation.
| Case Report|| |
An 8-year-old child was scheduled for open cholecystectomy for cholelithiasis under general anesthesia, with American Society of Anaesthesiologists (ASA) Grade I. His parents stated that he had no previous surgery, no chronic or immunocompromised diseases and no allergies. Physical examination did not reveal any associated anomalies or abnormalities. Preoperative hemogram, coagulogram, renal and liver function tests were normal and abdominal ultrasound revealed multiple gall stones.
Intravenous (IV) glycopyrrolate (0.004 mg/kg), Midazolam (0.2 mg/kg), and Fortwin (0.3 mg/kg) were given as premedication. General anesthesia was induced with IV Propofol (2 mg/kg), Succinyl choline (2 mg/kg), and Vecuronium (0.1 mg/kg). After mask ventilation, endotracheal intubation was done with ease. Patient was placed supine with head in neutral position. Duration of anesthesia was 90 minutes. Maintenance was done with IV Vecuronium (one fourth the induction dose), along with oxygen (40%) and nitrous oxide (60%) and Isoflurane (1-1.5% end-tidal concentration). Reversal was done with IV Glycopyrrolate (0.008 mg/kg) and Neostigmine (0.05 mg/kg). Patient was extubated without any problem, and recovery was uneventful.
Postoperatively, patient was placed on Amikacin 60 mg IV twice daily and Tramadol HS and calculated intravenous fluids administered till resumption of oral feeds as per protocol for primary disease.
Twenty-four hours after the surgery, patient developed a firm, diffuse enlargement of the left parotid gland with mild pain [Figure 1]. It was tender; no redness, warmth, or crepitus were noticed in the swelling. Tab serratiopeptidase 40 mg TDS was added, and oral hygiene was maintained with chlorhexidine mouth wash. Swelling regressed completely after 3 days.
| Discussion|| |
Anesthesia mumps was first reported by Atlas More Details et al.  Majority of cases occur in patients who undergo anesthesia for long duration.  However, in our case period of anesthesia lasted only for 90 minutes. Several postulates have been made in literature regarding etiology of this condition. Among possible theories is retrograde flow of air through Stensen's orifice during straining and coughing during anesthesia, retention of secretions in the salivary duct, use of drug like succinylcholine, atropine and morphine, and systemic dehydration. Vasodilatation and hyperemia in the parotid gland due to parasympathetic nerve stimulation during tracheal intubation. ,,, The position of the head during a prolonged surgical procedure may play a role in etiology in sitting or prone position. ,, In addition, viral and bacterial parotitis, pneumoparotitis, and allergic conditions will need consideration and exclusion.
Bilateral submandibular gland swelling even after regional anesthesia for hip replacement has been reported by Pirat et al.  They hypothesized that it could be due to the sympathetic stimulation caused by perioperative vasopressors or hypovolemia. Most of the cases reported in literature were noticed immediately following extubation; however, Ismail Kati et al have reported a case of anesthesia mumps after cesarean section in pregnant women 24 hours after surgery. In our case, also swelling was seen 20 hours after surgery.  Transient swelling of parotid glands are also reported after bronchoscopy and upper gastrointestinal diseases (GI) endoscopy. Vinu Jamwal and Vijant Singh Chandwal have reported three cases in which swelling of the right parotid gland appeared following upper GI endoscopy. It lasted only for 1-2 hours and recurred on repeat procedures (2-3 times) subsequently. 
It is possible that it is not a single factor but combination of factors like patients underlying disease, choice of anesthetic drug, surgical position, operative site (such as head and neck surgery), and induction methods (such as endotracheal tube, laryngeal mask inadequate insertion and fixation), which contribute to the development of acute swelling of parotid gland.  In our case, there was no evidence of any known diseases and induction of anesthesia was uneventful. Patient underwent surgery in neutral position, had a smooth induction and extubation course with head kept in neutral position. Anesthetic drugs used included fentanyl, rocuronium, isoflurane, propofol, which do not cause increase salivary secretion. IV Glycopyrrolate was used during reversal, which has a less secretory effect compared to atropine. The use of succinylcholine may be considered as a possible etiology for our case.
| Conclusion|| |
The aim of this case report is to draw attention of the surgical fraternity to this condition, which may be encountered in the immediate postoperative period and raises alarm but does not merit any aggressive management. It resolves spontaneously with symptomatic care.
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