A postoperative woman with sore throat.

CASE PRESENTATION

A 20‐year‐old female presented to the emergency department (ED) with a sore throat and progressive discoloration to her uvula that were first noticed 2 days ago. Three days prior, she underwent uncomplicated endoscopic sinus surgery for chronic rhinosinusitis. Intubation was performed by direct laryngoscopy using a Macintosh 4 blade and a size 7.0 cuffed endotracheal tube, requiring a single attempt, followed by an uneventful extubation. The patient was intubated a total duration of 127 minutes. On ED presentation her vital signs were within normal limits. Oropharyngeal examination revealed a demarcated white coating to the inferior third of the uvula (Figure 1).

FIGURE 1

Oropharynx of the patient on postoperative day 3 demonstrating a white coating to the uvula

DISCUSSION

Diagnosis: uvular necrosis

Uvular necrosis is an uncommon adverse event resulting from impingement by airway devices or vigorous suctioning during surgical procedures. , Patients may experience sore throat, foreign body sensation, coughing, and, in severe cases, infection or airway obstruction. , Uvular necrosis is a clinical diagnosis, often made with direct observation of an elongated, inflamed uvula with white exudates at the necrotic tip. Treatment course is usually conservative with antibiotics, corticosteroids, topical anesthetics, and nebulized epinephrine with sloughing of the necrotic tissue within 2 weeks. Rarely, severe cases require excision of the necrotic tissue.

Ear, nose, and throat (ENT) surgeons were consulted and recommended conservative management with a 7‐day course of amoxicillin‐clavulanic acid and nystatin mouthwash. No uvular lesions were noted at ENT follow‐up 9 days later, and the patient reported resolution of throat discomfort.