Midazolam is one of the most widely used sedative agents in gastroenterology practice
for conscious sedation before short endoscopic procedures [1]. We report a case of transient swelling of the parotid gland after midazolam administration.
A 55-year-old woman with suspected peptic ulcer underwent upper gastrointestinal endoscopy.
Before the procedure 2 mg intravenous midazolam was administered. Lidocaine spray
was used for local anesthesia. A few minutes after the procedure she complained of
swelling on the left side of her neck. Palpation showed a firm mass without erythema
or tenderness in the parotid gland region ([Fig. 1]). Her previous medical history was unremarkable except for mumps when she was a
child. Laboratory findings were normal. Neck ultrasonography revealed parotitis without
salivary duct calculi or lymphadenopathy. The swelling disappeared spontaneously after
48 hours. She had no further complaint of this nature during 3 months’ follow-up.
Fig. 1 A mass on the left parotid gland.
Acute and chronic swelling of the salivary glands may occur in various disorders including
mumps, postoperative parotitis, amyloidosis, tuberculosis, and some autoimmune disorders
and malignancies. Noninflammatory parotid enlargement is seen occasionally in association
with malnutrition, obesity, and liver disease [2].
Swelling of the salivary glands after general anesthesia, termed “anesthesia mumps”,
is a rare event. It has been reported after endotracheal intubation, bronchoscopy,
and upper gastrointestinal endoscopy [3]. The conditions are usually unilateral and painless and spontaneously resolve in
a few hours. Although the exact mechanism is not fully understood, retrograde passage
of air due to a loss of muscle tone around Stenson’s orifice, retention of secretions
causing a blockage of the salivary ducts, dehydration, and head positioning during
the procedure may have a pathogenetic role [4].
All “anesthesia mumps” cases in the literature have been attributed to general anesthesia.
Our case report is unique in describing this complication after conscious sedation
with midazolam.
Endoscopy_UCTN_Code_CPL_1AH_2AB
