title: Acute unilateral submandibular gland swelling associated with the laryngeal mask airway.
abstract: We describe a rare complication of acute unilateral submandibular gland swelling following the use of laryngeal mask airway (LMA) in two patients with otherwise uneventful perioperative airway management. This is likely to be a consequence of the pressure exerted by the airway cuff on the tissues within the submandibular triangle. As this complication is rarely reported, its true incidence may in fact be higher, suggesting a need for greater attention on LMA cuff pressures and degree of cuff inflation. We discuss the presenting clinical features, pathophysiology and utilisation of ultrasonographic confirmation of sialadenopathy, and review the current anaesthetic literature to raise awareness of this unusual and under-reported complication of LMA. This complication can be mitigated by incorporating routine manometric checks and limiting intracuff pressures to < 60 cmH2O, potentially avoiding LMA insertions in patients with sialolithiasis and avoiding the use of nitrous oxide.
authors.affiliation: Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889. tsuhitharan@yahoo.com.
authors.forename: Thangavelautham
authors.initials: T
authors.lastname: Suhitharan
authors.affiliation: Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889. tsuhitharan@yahoo.com.
authors.forename: Sathyendran
authors.initials: S
authors.lastname: Seevanayagam
authors.affiliation: Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889. tsuhitharan@yahoo.com.
authors.forename: Francis Christopher
authors.initials: FC
authors.lastname: Parker
authors.affiliation: Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore 529889. tsuhitharan@yahoo.com.
authors.forename: Wendy Hui Ling
authors.initials: WH
authors.lastname: Teoh
mesh_terms: D000328:Adult; D000777:Anesthetics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D011312:Pressure; D013363:Submandibular Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
chemical_list: D000777:Anesthetics