Anesthesia mumps and morbid obesity

Area of Science:

• Anesthesiology
• Surgical Complications
• Obesity Medicine

Background:

• Parotid gland swelling is a rare complication associated with general anesthesia across various patient demographics and surgical procedures.
• This condition, while uncommon, necessitates awareness among healthcare providers for accurate diagnosis and management.
• The association between morbid obesity and this complication has not been widely reported.

Observation:

• A 45-year-old morbidly obese female (BMI 50.5 kgm-2) developed unilateral painful parotid gland swelling postoperatively.
• The swelling occurred on the dependent side after surgery for a left humerus fracture, managed with the patient in a right lateral position.
• Head positioning during surgery utilized a soft bandage head ring, a standard practice for such procedures.

Findings:

• The case suggests a potential link between morbid obesity and parotid gland swelling post-surgery.
• A proposed mechanism involves the unique cervical anatomy of morbidly obese patients, leading to vascular compression and compromised blood flow.
• This compromised perfusion may result in ischemic sialadenitis, manifesting as parotid gland swelling.

Implications:

• Physicians should consider parotid gland swelling as a potential complication in morbidly obese patients, especially after procedures requiring specific positioning.
• Recommendations include minimizing neck manipulation and ensuring adequate facial padding during surgery.
• Discouraging the use of head rings for head positioning in morbidly obese patients may help prevent this complication.