Uvular Necrosis Caused by Impingement During Intubation (Days 1-3)

I recently underwent a relatively low-risk procedure that required general anesthesia, and was intubated. The procedure went fine, with no complications, but the intubation caused severe ulcerations of my uvula and the tissues surrounding my soft palate. I didn’t know at the time, but it soon became clear that I had uvular necrosis.

Immediately after the procedure, I noticed significant pain in my throat, particularly when swallowing. Both I and my wife told the hospital staff that my throat hurt, but they just told us that it was normal to have a sore throat after intubation. It probably wouldn’t have changed anything if they had actually looked at my throat, but still, it would have been nice to have been heard. This is my story of developing uvular necrosis, which I am writing 48 hours after my procedure.

The Morning After

Here is a picture of my uvula taken the morning after my procedure (roughly 22 hours after intubation). The ulceration, which occurred midway up the uvula and around the soft tissues, had already started to scab over. The tip, however, was quite purple.

There was (is, at the time of this writing) a significant amount of dysphagia and pain every time I swallow — which it turns out is quite a bit, now that I’m aware of it!

What I Sent to the Doctor

I reached out to the doctor who performed the procedure, and sent him the following pictures:

In the meantime, I started doing research on the internet about this. I found out that necrosis of the distal uvula is a rather rare complication of intubation. Research indicates that uvular necrosis occurs due to the impingement of the uvula by the intubation instrument against the hard palate of the mouth. Essentially cutting off the blood supply to that part of the body, and thus, killing the uvula tissue. Other sources indicate that it could be caused by ‘aggressive oropharyngeal suctioning’. Admittedly, I wasn’t awake to make the distinction.

According to the RN that works with him, the doctor and the anesthesiologist both saw the pictures and felt the best course of action was to gargle with salt water and suck on throat lozenges. Shortly thereafter, the doctor followed up and suggested gargling with antiseptic mouthwash, such as Chlorhexidine. Side note: Chlorhexidine is some pretty serious stuff and can cause significant staining on your teeth, so avoid drinking coffee or wine when using it. I’ve chosen to use Listerine, instead, which claims to be an antiseptic mouthwash as well. I’m also gargling with sea salt water several times a day, and using oral analgesic spray. Sadly, none of it stops the pain when I swallow.

Two Days Later

I followed up with the doctor again, roughly 48 hours after the procedure, and sent him the following pictures. Interestingly enough, he told me what I’m experiencing is not really uvular necrosis. It is inflammation. Uvulitis, specifically. I admit, I wasn’t expecting him to say that. Uvulitis is inflammation of the uvula. Yes, my uvula is about and inch and a half long, and you can see I have no problem pulling it forward and having it rest on my tongue (which is not normal!). But I was very surprised to hear that he didn’t think this was uvular necrosis.

I sent the doctor a link to the New England Journal of Medicine (click here for the article). The article clearly shows uvular necrosis of the distal uvula with a picture of an uvula that looks exactly like mine. The doctor prescribed acetaminophen for the pain. For that particular patient, the uvula spontaneously sloughed off approximately four days after his own procedure.

I guess that implies I have two more days to go before I can hope for the same outcome.

It hurts to swallow. It is hard to eat. Medicines and pain relievers don’t seem to be working. And it is disrupting my sleep. It isn’t a terrible problem, but it is annoying as can be. And it’s not great that my doctor and I disagree on whether the tip of my uvula is necrotic or not. That shouldn’t be something where there is a lot of room for debate. If you read this and have an opinion, please feel free to share.

I hope this article helps anyone suffering through the same problem that I am having.

Three Days Later

It has been just over 72 hours… there has been little change in my uvula. Throat still hurts, almost constantly, particularly when I swallow, but the intensity of the pain had declined.