ABSTRACT
A 42-year-old male was scheduled for left fronto-temporo-parietal craniotomy and subdural hematoma removal under general anesthesia. The past history was diabetes mellitus, hypertension, and chronic alcoholism. He was moderately obese, short neck, and deep drowsy. After rapid sequence induction with fentanyl, thiopental sodium and succinylcholine, anesthesia was maintained with nitrous oxide-oxygen-isoflurane. His head was fixed on horseshoe head rest with right side tilted. Throughout the 4 hours of anesthesia, cardiovascular and respiratory variables remained within normal limit. After extubation, upper respiratory obstruction developed, presumably as the result of the tongue's falling back against the posterior pharyngeal wall. This was only partly corrected by insertion of a rubber oral airway, but it was fully relieved when the lower jaw was lifted forward by bilateral digital pressure applied behind the angles of the mandible about ten minutes. At the intensive care unit, left partial facial nerve paresis developed with mild weakness of the right corner of the mouth, and striking right parotid swelling and tenderness. The parotid swelling receded over 2 weeks, and the paresis resolved over 3 weeks to complete recovery.