Uvula Necrosis After Endotracheal Intubation for Rhinoplasty

Abstract

We report on a case of distal uvula necrosis after endotracheal intubation for rhinoplasty. A 20-year-old man presented for primary rhinoplasty. There was no history of an upper respiratory tract infection and he was a nonsmoker. The trachea was successfully intubated with a size 7.5 cuffed tracheal tube using a Mackintosh blade. The surgical procedure was completed in 2 h. The postoperative period was uneventful except for a sore throat that began in the recovery room. Following splint removal he complained of the sensation of a foreign body in his throat. Physical examination revealed an elongated and edematous uvula with 1 9 1-cm measured white tissue at the distal uvula with a clear demarcation line (Fig. 1). The tip of the uvula was excised under local anesthesia (Fig. 2). He had instant relief of the foreign body sensation, however, the sore throat persisted for 1 week more. He made a complete recovery. Although a sore throat after endotracheal intubation is a common event [1], uvular necrosis is rare [2]. When nonresolving sore throat after tracheal intubation is associated with a foreign body sensation or difficulty in swallowing, the oropharynx should be examined [1]. Aside from direct pressure applied against the posterior pharynx by the endotracheal tube, the uvula can be traumatized during oropharyngeal suction [2]. Treatment options reported in the literature include observation, intravenous steroids, antihistamines, and topical epinephrine administration [3–5]. Conservative management is frequently advised based on the patient’s symptoms [2]. Excision of the necrosis should be an alternative to conservative therapy. Uvular necrosis is felt to be secondary to a mechanical interruption of the blood supply to the uvula. Midline placement of the tube can cause excessive compression of a long uvula [1]. Rhinoplasty operations may last more than an hour depending on the patient’s degree of deformity and septal deviation. Midline placement of the tube is frequently G. T. Calikapan Division of Plastic, Reconstructive and Aesthetic Surgery, Kilis Government Hospital, Kilis, Turkey