Postoperative Sialadenitis: A Rare Complication of Park Bench Positioning for Neurosurgery

Keywords

sialadenitis - patient positioning - neurosurgery - craniotomy

Introduction: Neurosurgical procedures require specific and often unique positions to maximize anatomical exposure. Prolonged surgeries demand maintenance of these positions for long durations. Retrosigmoid–suboccipital craniotomy for cerebellopontine angle tumor is one such technique which requires placing the patient in Park Bench position. Various complications are attributed to this position.[ ¹ ] A rare and serious complication is postoperative submandibular sialadenitis along with diffuse soft tissue swelling of the neck occurring following extreme degrees of head positioning.[ ² ] This can cause severe respiratory distress postoperatively.

Methodology/Description: We report a case report of a 42-year-old, ASA-I, male patient diagnosed with right vestibular schwannoma, posted for retrosigmoid–suboccipital craniotomy and excision in a right Park Bench position. The surgery lasted for 8 hours and patient was extubated at the end of surgery uneventfully. After 4 hours, he started developing acute left sided hemifacial swelling which was diagnosed as acute submandibular sialadenitis with diffuse soft tissue swelling of the same sided oropharyngeal mucosa. The patient consequently developed respiratory distress and stridor, requiring reintubation. The swelling gradually diminished and he could be extubated on the second postoperative day. Complete resolution took approximately 5 days with conservative treatment. Multitude of etiological factors, attributed to this occurrence, and the various remedial measures have been discussed.

Conclusion: Acute postoperative sialadenitis is a rare complication after Park Bench positioning in neurosurgery. Although it has a good prognosis with conservative management, utmost vigilance is required for possible development of respiratory compromise. Meticulous attention to preoperative oral hygiene and intraoperative positioning probably can prevent its development.

• References

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