Acute Sialadenitis After Intubation.

Acute post-operative sialadenitis can be caused by duct obstruction or submandibular gland injury. Although rarely presenting, it is thought that during surgery, the intra-operative head and endotracheal tube position leads to compression of the submandibular gland and surrounding tissues, thereby effectively limiting drainage (1). The patient in our study was a 42-year-old woman with no remarkable medical history who underwent right retrosigmoid craniotomy for resection of a brain mass. Her surgery proceeded without complication, and she was uneventfully extubated. On post-operative day 1 (POD1), the patient developed severe left neck swelling, although no stridor or wheezing was noted on lung examination. Computed tomography (CT) revealed a profoundly oedematous left submandibular gland (Figure 1). Patients who develop acute sialadenitis may experience severe upper airway swelling and obstruction, thus necessitating intubation.

Figure 1. a–c

(a) Axial (b) sagittal and (c) coronal computed tomography findings demonstrate prominent enhancement of the oedematous left submandibular gland with significant adjacent oedema and inflammatory stranding. No evidence of a sialolith suggests intra-operative drainage obstruction as the inciting cause