Authors: De Freitas M A et al.
Journal: Cureus, Volume 15, Issue 9, Article e45132, 10.7759/cureus.45132
Summary
This case report describes the day-to-day clinical progression of postoperative uvular necrosis following endotracheal intubation for right shoulder acromioclavicular joint reconstruction in a healthy 22-year-old male. Uvular necrosis is a rare complication attributed to mechanical compression and ischemia of the uvula from oropharyngeal devices used during airway management.
Symptoms began within 24 hours of surgery and progressed from severe throat pain to odynophagia, dysphagia, and nocturnal choking sensations caused by transient airway obstruction in the supine position. Serial oropharyngeal examinations documented a predictable evolution from erythema to well-demarcated necrosis involving up to 80% of the uvular surface, followed by gradual resolution over several days. Conservative management with acetaminophen, ice chips, positional modification, and reassurance was sufficient, and no antibiotics, corticosteroids, or surgical intervention were required.
The report is notable for its detailed daily photographic and clinical documentation, demonstrating that symptom severity often peaks around postoperative days two to three before improving. Complete symptom resolution occurred without long-term sequelae, and one-year follow-up confirmed normal uvular anatomy and function. The authors emphasize that postoperative uvular necrosis is self-limiting in most cases but can cause significant patient distress and airway symptoms during its acute phase.
What You Should Know
Persistent severe throat pain, odynophagia, or choking sensations more than 24 hours after airway instrumentation should prompt direct oropharyngeal examination, as uvular necrosis is uncommon but distressing and often underrecognized.
Key Points
• Uvular necrosis is a rare postoperative complication linked to mechanical compression during airway instrumentation.
• Symptoms typically begin within 24 hours and peak over the next 2–3 days.
• Conservative management is usually sufficient, with full resolution expected.
• Supine positioning may worsen symptoms due to transient airway obstruction.
• Long-term sequelae are uncommon based on available follow-up data.
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