title: Parotitis after epidural anesthesia in plastic surgery: report of three cases.
abstract: BACKGROUND
  Acute swelling of the parotid glands after general anesthesia has become known as anesthesia mumps. Its cause is unknown. Only one case of postsurgical parotitis without general anesthesia is reported. This report describes three cases in this setting after plastic surgery.
  
  
  METHODS
  A 37-year-old women underwent breast surgery and abdominoplasty with a dual thoracic/lumbar epidural block (bupivacaine 0.5 %). The operative time totaled almost 6 h. Subsequently, 4 h after surgery, the patient experienced painless bilateral parotid swelling without palpable crepitus. The edema resolved completely within 12 h under clinical observation and parenteral hydration.
  
  
  METHODS
  A 45-year-old patient received subglandular breast implants and body contouring with liposuction, all with the patient under a dual thoracic/lumbar epidural block with 0.5 % marcaine. The total surgical time was 5 h. Subsequently, 3 h after surgery, the patient experienced a similar clinical presentation. The problem resolved completely in 36 h with clinical observation and parenteral hydration. CASE 3: A 30-year-old patient received a subglandular breast implant and underwent liposuction of the outer thighs using a dual thoracic/lumbar epidural block with lidocaine 1 %. The duration of surgery was 1 h. Subsequently, 5 h postoperatively, the patient experienced a similar clinical presentation. Dexamethasone and parenteral hydration were administered. The problem resolved completely in 48 h without sequelae.
  
  
  CONCLUSIONS
  The occurrence of parotitis in patients undergoing surgery under epidural anesthesia is a novel situation, which increases the range of possible etiologies for this little known condition. Dehydration leading to transient parotid secretion obstruction may play a significant role. Further reports of parotitis occurring in the regional anesthesia setting are expected to help elucidate its pathophysiology.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Master Hospital of Plastic Surgery, Rua 1123, n. 232, Setor Marista, Goiania, GO, Brazil. rosiqueplastica@doctor.com
authors.forename: Marina Junqueira Ferreira
authors.initials: MJ
authors.lastname: Rosique
authors.forename: Rodrigo Gouvea
authors.initials: RG
authors.lastname: Rosique
authors.forename: Ilson Rosique
authors.initials: IR
authors.lastname: Costa
authors.forename: Brunno Rosique
authors.initials: BR
authors.lastname: Lara
authors.forename: Jozé Luiz Ferrari
authors.initials: JL
authors.lastname: Figueiredo
authors.forename: Davidson Gomes Barbosa
authors.initials: DG
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D003681:Dehydration / Q000150:complications; D005260:Female; D006801:Humans; D008875:Middle Aged; D010309:Parotitis / Q000209:etiology*; D056888:Patient Positioning; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures