LMA Associated Sialadenopathy
Samuel J. Velez, MD, Joshua Fuhrmeister, MD,
R. Victor Zhang, MD, Ph.D.
Department of Anesthesiology, University of Florida, Gainesville, Florida
ABSTRACT
Inflammation of salivary glands rarely occurs in anesthesia practice. Since
first described in 1965, several reports of sialadenopathy have been
reported. Sialadenopathy is usually associated with endotracheal intubation,
perioral endoscopic procedures under local anesthesia and the use of
atropine and succinylcholine. More recently, sialadenopathy has been
associated with placement of the LMA (Laryngeal Mask Airway).
Case Report: A 38 year-old woman, ASA class III, presented for removal of a
Tenckhoff peritoneal dialysis catheter. Her past anesthetic history was
significant for a history of sore throat and one episode of tongue swelling
found post-extubation. After induction a lubricated size 4 standard LMA was
placed easily using the standard technique. Surgery was uneventful and
lasted approximately 30 minutes. Hours later, the patient began to complain
of increasing sublingual pain. Examination revealed an engorged and
hyperemic sublingual gland. Over the next two days the swelling and pain
dissipated. There were no long-term sequelae.
Discussion: Sialadenopathy associated with LMA use is postulated to occur as
a result of gland and ductal deformation secondary to obstruction of
salivary drainage1. The large volume that the LMA occupies in the oropharynx
displaces and transmits pressure to adjacent tissues; leading to obstruction
of salivary drainage with resultant gland enlargement and inflammation , .
The combination of a small oropharynx and the use of a large sized LMA,
despite using the recommended cuff volumes, may lead to this rare
complication. Vigilance for increase cuff pressure with the use of nitrous
oxide is relevant.
Conclusion: In order to minimize the risk of local neurovascular
compression, one should consider previous history of tongue swelling after
anesthesia, the size of the oropharyngeal cavity, the size of the LMA, cuff
volumes, and anesthetic agents used. This may be an effective way of
minimizing the risk for injury.
