Anesthesia mumps and morbid obesity

Parotid gland swelling during/after surgery is a rare but known complication of general anesthesia. It has been found to be associated with patients of all age groups and various surgical procedures. We have found this rare complication to be associated with morbid obesity as well. A forty five year old morbid obese lady(BMI 50.5 kgm-2) was operated for fracture shaft of left numerous after positioning in right lateral position. Intraoperatively, her head was positioned using soft bandage head ring used commonly for such positioning. Postoperatively unilateral painful parotid gland swelling was noted on the dependent(right) side of face. Possible mechanism for such a scenario could be the vulnerable anatomy of short thick neck of morbid obese patient leading to compression of its vessels and compromising perfusion of the area supplied, hence resulting in ischemic sialadenities. Physicians treating these patients should be aware of this condition to avoid misdiagnosis. Minimum turning of neck should be allowed and proper padding of face should be done to avoid occurence of this potentially harmful complication. Also, use of head ring for positioning the head should be discouraged.