To the Editor:-The oropharyngeal airway is commonly used to maintain a patent airway and to prevent endotracheal tube occlusion. However, it can also result in various complications like trauma to lips, teeth, and uvula and ulceration and necrosis of tongue. We report the occurrence of transient unilateral sialadenopathy, which we believe was a result of oropharyngeal airway. The patient was a 40-yr-old, thin, American Society of Anesthesiologists' physical status I woman undergoing esophagectomy. Tracheal intubation was performed with left-sided 37 FG Robertshaw double lumen tube (Rusch, Germany) after a smooth induction with atropine, thiopentone, and succinylcholine. After the tube fixation, a Guedel oropharyngeal airway, size 3 (Intersurgical, UK), was inserted, and head and neck were turned to the right. Three minutes later, a subcutaneous, noninflammatory, well- circumscribed, firm swelling was noticed just beneath the left side of the mandible. Pressure over the swelling caused no change in its size. The head was immediately straightened, and airway was removed. The swelling persisted, thus, ruling out the airway tip itself to be the cause. There was no increase in salivation. Subsequently, the swelling decreased and disappeared completely after 20 min.
In 1969, Slaughter et al. observed an episode of sialadenopathy during endoscopy. They postulated that swelling was either a result of the endoscope pushing the posterior portion of the tongue forward and downward, thus dislocating the submandibular gland, or a result of temporary occlusion of gland duct by the endoscope, resulting in gland enlargement. Subsequently, Smith et al. described a case of unilateral swelling similar to ours and attributed the event to the administration of atropine and succinylcholine, whereas Rubin et al. postulated that swelling could occur as a result of straining during intubation or extubation. The exact etiology of this remains obscure. We believe that the etiology of the swelling seen in our situation is probably a result of airway tip temporarily occluding the submandibular duct or as a result of distortion of base of the tongue thus pushing the gland outward. Other causes of neck swellings like acute allergic reactions, angioneurotic edema, and hemorrhage could be ruled out in our case because the swelling was transient, not associated with allergic manifestations, and subsided without treatment. Although these glandular enlargements usually regress spontaneously in minutes, hours, or days, these may or may not be associated with any sequelae. Thus, we suggest that in cases of sialadenopathy one should also took for oropharyngeal airway as the cause, and its removal may help in early regression of the swelling.
Ruchi Gupta, M.D.
Department of Anesthesiology; Post Graduate Institute of Medical Science; Rohtak 124001; Haryana, India
(Accepted for publication October 3, 1997.)