Uvular injury: A narrative review

Uvular injury, although rare, is a clinically significant complication of airway and pharyngeal manipulation and procedural intervention across multiple specialties including anesthesiology, otolaryngology, gastroenterology, obstetrics and gynecology, pediatrics, emergency medicine, and infectious disease. This narrative review comprises case reports and series from MEDLINE and Embase databases and Google Scholar from 1978 to 2025 outlining the embryological origin and anatomy of the uvula, the pathophysiology and management of uvular injury, and preventative measures. Common etiologies can be classified into mechanical injury from airway instrumentation, nonmechanical injury from isolated uvular edema, infection and drug reactions, pediatric uvular injury, and idiopathic uvular injury resulting in an array of injuries from uvular edema to necrosis, paralysis, and hematoma. Typically, uvular injuries present with sore throat, odynophagia, dysphagia, foreign body sensation, and, in more severe cases, airway obstruction. On physical exam, the uvula may appear erythematous, edematous, and necrotic or avulsed in severe cases. Uvular injuries commonly resolve with conservative management such as analgesics and anti-inflammatory medications. Antibiotics and surgical intervention are rarely indicated as most injuries resolve within 2 weeks. Recommendations for prevention of mechanical injury include device placement lateral to the midline, gentle and controlled suctioning, and careful patient positioning. Currently, there is a lack of standardized management guidelines for uvular injury. One proposed grading system categorizes uvular injury by Grade I-IV ranging from mild edema and uvulitis to uvular necrosis and autoamputation. However, future large-scale studies are warranted to standardize management protocols and guidelines.