Acute Contralateral Submandibular Sialadenitis as a Complication of Skull Base Surgery

Abstract

A 51-year-old woman presented with a 2.5 year history of numbness, tingling and progressive pain involving the right lateral tongue and anterior neck just inferior to the mandible. An unrevealing extensive imaging workup and a positive response to an anesthetic injection targeting the right glossopharyngeal nerve led to the diagnosis of glossopharyngeal neuralgia. After an unsuccessful attempt at medical therapy a suboccipital microvascular decompression was performed via a right suboccipital craniectomy. Immaculate hemostasis was reportedly achieved during surgery lasting approximately 2 h and 40 min. Acutely in the postoperative setting the patient was noted to have progressively worsening left cervical swelling and significant weakness with abduction of the left shoulder. Because of concern for an enlarging hematoma, potential airway compromise and the patient’s contrast allergy, a non-contrast neck computed tomography (CT) was carried out. The non-contrast soft tissue neck CT demonstrated an enlarged, moderately hypoattenuating left submandibular gland with multiple dilated intraparenchymal ducts (Fig. 1). Both superficial and deep inflammatory changes were present (Figs. 1, 2). superficially, the overlying platysma muscle and skin were thickened with soft tissue stranding in the overlying fat. An associated extensive amount of infiltrative low-attenuation fluid and inflammatory changes extended to the deep neck spaces (Figs. 1,2) involving left submandibular, sublingual, masticator, parapharyngeal, carotid, retClin neuroradiol (2012) 22:161–163 doI 10.1007/s00062-011-0078-1