A 26-year-old 70-kg male patient presented to the surgical department with bilateral gynecomastia for the past 6 months that caused him to have significant social and psychological distress. His past medical history was unremarkable, and he did not have any relevant history for use of drugs, supplements, allergies, or genetic disorders.
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On examination, he was vitally stable with pulse 86-bpm blood pressure 120/80 mmHg, respiratory rate 16 breaths per minute, temperature 97.8 °F, and SpO2 of 95% at room air. He had bilateral symmetrical gynecomastia. The systemic examination was unremarkable. There was no significant history or examination finding that would explain the patient’s gynecomastia and was thus considered as an idiopathic case. He was planned for a subcutaneous mastectomy under general anesthesia as a day-care surgery.
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He was classified as ASA grade 1, Mallampati class 1, and Cormack-Lehane grade 1. General anesthesia was induced with midazolam 1 mg, propofol 120 mg, and atracurium 40 mg. The trachea was easily intubated with a single-lumen polyvinyl-chloride ETT with an internal diameter of 7.5 mm using a Macintosh laryngoscope blade size 3 and fixed at the 21-cm mark. Per-operative analgesia was given using morphine 6 mg and paracetamol 1 g. The surgery lasted 95 min and was uneventful. The neuromuscular blockage was reversed using atropine 1.2 mg and neostigmine 2.5 mg. The patient was extubated once he was fully awake and was shifted to the recovery room.
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About 2 h after surgery, the patient complained of having sore throat for which he was advised diphenhydramine syrup. On the second postoperative day, he complained of persistent cough, feeling of something “stuck to the back of the throat,” and halitosis. An otorhinolaryngology review was done. On examination of the oropharynx, the uvula had a well-demarcated dark-red gangrenous ulcer, and the base of the uvula was hyperemic (grade III uvular injury).
His condition was diagnosed as postoperative uvular necrosis and was managed conservatively. He was prescribed ammonium hydroxide mouthwash and normal saline gargles. On the 5th postoperative day, the necrosed segment of the uvula sloughed off spontaneously (Fig. 1). Afterwards, the patient had complete resolution of his symptoms. He was called for a follow-up after 2 weeks to the surgical outpatient department. His symptoms were completely resolved, and on examination, his uvula was shortened; however, there was no signs of erythema, necrosis, or slough indicating resolution of uvular injury.
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