Pneumoparotitis

Etiology of Pneumoparotid: A Systematic Review

Pneumoparotid describes retrogradely insufflated air within the Stensen's duct and/or parotid gland. It is a rare condition with variable causative factors. This study aimed to elucidate the clinical characteristics of pneumoparotid. Reports in all languages were evaluated following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2020. A literature search was conducted using electronic medical databases (PubMed, Scopus, Web of Science, EBSCO, Ovid, Google Scholar, SciElo, LILIACS, and others) from 1890 to 30 June 2022. One hundred and seventy patients (mean age; 28.4 years) from 126 studies were reviewed. Common symptoms included swelling (84.7%) and pain (35.9%). Characteristic findings were crepitus in the parotid region (40%) and frothy saliva from the orifice (39.4%). The common etiologies included abnormal habits such as blowing out the cheeks (23.5%), idiopathic (20%), self-induced (15.9%), playing wind instruments such as trumpets or flutes (8.8%), and diseases inducing coughing or sneezing (8.2%). The treatments included antibiotic therapy (30%), behavioral therapy to avoid continuing causative habits (25.9%), psychiatric therapy (8.2%), and surgical procedures (8.2%). Treatment should be individualized and etiology-based. However, the etiology was not identified in 20% of patients. Further detailed data from larger samples are required to clarify and improve the recognition of this entity.

Acute Bilateral Swelling of the Parotid Gland After General Anesthesia in Lateral Decubitus Position

A rare but well-known anesthetic side effect is acute parotid gland enlargement after general anesthesia, sometimes known as anesthesia mumps or acute post-operative sialadenitis. Acute dehydration, obstruction of glandular excretory ducts caused by the position of the patient, and/or medications such as atropine that increase saliva viscosity have all been proposed as potential causes, while the specific cause is still unknown. We present a case of a 41-year-old patient who underwent a right open anatrophic pyelolithotomy for a staghorn calculus in the left lateral decubitus position and had swelling in the right and left preauricular and postauricular regions, which had progressed to the angle of the mandible post-operatively.

Pneumoparotid and Pneumoparotitis: A Literary Review

Pneumoparotid is a rare condition of parotid swelling. The presence of the air in gland parenchyma is caused by an incompetent Stensen’s duct with high pressure may cause the acini’s rupture. We reviewed 49 manuscripts, from 1987 to today, that enrolled a total of 54 patients with pneumoparotid. Our review evaluated the following evaluation parameters: gender, age, etiology, clinical presentation, treatment, days of resolution after diagnosis, relapse and complications. The most frequent etiology is self-induction by swelling the cheeks (53.7%). This cause mainly involves children (74%), for conflicts with parents, excuses for not going to school, nervous tics or adults (16%) with psychiatric disorders. Iatrogenic causes are also frequent (16.6%), for dental treatments (55.5%) or use of continuous positive airway pressure (CPAP) (33.4%). Medical therapy is the most practiced (53.7%), in most cases it is combined with behavioral therapy (25.9%) or psychotherapy (25.9%). Surgery is rarely used (9.2%) as a definitive solution through parotidectomy (50%) or ligation of the duct (50%). The most common complication is subcutaneous emphysema (24.1%), sometimes associated with pneumomediastinum (5.5%). Careful treatment and management are necessary to ensure the resolution of the pathology and counteract the onset of complications.

Recurrent Pneumoparotid: Cause and Treatment

OBJECTIVE: To document the etiology and successful treatment of severe recurrent pneumoparotid.

STUDY DESIGN: Computed tomography, ductal measurement by probe size, surgical treatment.

RESULTS: We performed a superficial parotidectomy for a 13-year-old with a history of recurrent parotitis. He subsequently developed recurrent pneumoparotid in the contralateral gland with subcutaneous dissection of air into the face, neck, and mediastinum. At surgery, Stensen's ducts were measured and found to be abnormally patent bilaterally compared to standardized norms. Parotid duct ligation, commonly used for sialorrhea, was employed as a novel treatment and was curative.

CONCLUSION: Insufflation of air into the parotid duct system can trouble woodwind instrument players, can complicate dental procedures, or can be self-induced. It is generally a benign condition requiring no therapy. Occasionally, pneumoparotid can be recurrent and lead to inflammation and infection of the parotid or subcutaneous emphysema.

SIGNIFICANCE: In selected cases of recurrent pneumoparotid, ductal ligation may be curative.

[Pneumoparotid: a rare cause of recurrent parotid swelling]

INTRODUCTION

Pneumoparotid is a rare cause of recurrent parotid swelling. It is often fortuitous, caused by an action inducing intraoral pressure, increased or self-induced.

OBSERVATION

An 8-year-old boy presented with recurrent right unilateral parotid swelling for 2 years. A CT-scan was performed, outside of the acute phase, which revealed the presence of intraparotid air bubbles.

DISCUSSION

Pneumoparotitis results from air flowing back into Stensen's duct, due to an anatomical abnormality and a significant increase of intraoral pressure. The diagnosis is made on clinical examination, often completed by a morphological examination (cervicofacial CT-scan or parotid ultrasound investigation). The outcome is most often favorable, with symptomatic treatment, and sometimes antibiotic prophylaxis. Patient education is the best means to prevent recurrence.

Acute unilateral parotid gland swelling after lateral decubitus position under general anesthesia

Acute swelling of the parotid gland after general anesthesia (commonly known as anesthesia mumps or acute postoperative sialadenitis) is a rare but declared complication of anesthesia. The etiology is not clear, but some possible causes such as obstruction of glandular excretory ducts caused by patient position and increase in the viscosity of the saliva because of acute dehydratation and/or medications like atropin have been proposed. We report a swelling in the left preauricular and postauricular region extending to the angle of the mandibule in a 35-year-old patient after left lateral decubitus position for laparoscopic nephrectomy.

Pneumoparotitis: a case report

BACKGROUND

Pneumoparotid is a rare cause of parotid enlargement. Pneumatic enlargement of the gland is caused by retrograde insufflation via Stensen's duct. Most reported cases have been managed conservatively, thus running a short course.

METHODS AND RESULTS

We report on a case of a 48-year-old man with a chronic painful right facial swelling and symptoms of repeated infection. Clinical examination found a parotid swelling with surgical emphysema and a dilated Stensen's duct. Pneumoparotitis with cystic changes and dilated intraparotid ducts was confirmed by CT. The patient proceeded to undergo excision of the gland, with subsequent resolution of symptoms.

CONCLUSION

Repeated retrograde movement of air and contaminated saliva leads to chronic infection and sialectasis. Management is aimed at preventing these sequelae by identifying and addressing the insult early; however, repeated pneumoparotid leads to chronic pneumoparotitis, the management of which is excision of the gland.

Pneumoparotitis: a diagnostic challenge

Pneumoparotitis is a rare cause of recurrent parotid swelling and its diagnosis can be challenging if the patient does not present with typical symptoms and is not in a risk group for parotitis. Several diagnostic techniques have been described in the literature including plain radiography, sialography and CT scanning. This report suggests that ultrasound is an efficient diagnostic aid and should be routinely used for the diagnosis of this condition.

Pneumoparotid: A Case Report and Review of its Pathogenesis, Diagnosis, and Management

Pneumoparotid is considered to be a rare entity, but the diagnosis might not be as uncommon as reported. We report a case in which computed tomography incidentally revealed air in the parotid ducts bilaterally. Treatment is aimed at the elimination of predisposing and causative factors, but because our patient denied any symptoms or precipitating factors and had a benign presentation, no immediate intervention was initiated.

Pneumoparotid due to spirometry

Pneumoparotid has been described in patients who generate increased intraoral pressures when playing wind instruments, while coughing, and when undergoing dental work. Some patients have intentionally created pneumoparotid to avoid duties at school or in the military, or to gain attention. We describe a patient who developed pneumoparotid during pulmonary function testing. The diagnosis of pneumoparotid depends on a suggestive clinical situation and glandular swelling with or without crepitus. Observation of aerated saliva per Stensen's duct or air in the parotid duct and/or gland by any imaging study is diagnostic if infection with a gas-forming organism can be reasonably excluded. No specific treatment is required, other than the avoidance of predisposing activities.

Acute viral and bacterial infections of the salivary glands

Acute infection can involve any salivary gland, but it predominately affects the major salivary glands, especially the parotid gland. The anatomic and physiologic factors accounting for the parotid gland's predilection for infection are reviewed. Numerous conditions that are predisposed to acute bacterial sialadenitis and differ from risk factors associated with viral infection are also reviewed. The pathogenesis, diagnostic evaluation, treatment, complications, and prognosis of bacterial infections are discussed and contrasted with those of viral infections.

Pneumoparotitis, subcutaneous emphysema and pleomorphic adenoma

Self-induced pneumoparotitis is a distinct clinical entity which should be considered in any inflammatory swelling of the parotid gland. When complicated by subcutaneous emphysema, other more important causes should be excluded. An unusual case is presented, which was further complicated by the presence of a pleomorphic adenoma.

Pneumoparotitis with orthodontic treatment

Self-induced pneumoparotitis has not been commonly associated with orthodontic treatment nor dental treatment in general. However, the patient described previously and the other reported cases demonstrate the distinct possibility that accommodation to appliance irritation by "puffing out" the cheeks could result in parotid swelling. Pneumoparotitis should definitely be considered in the evaluation of patients with parotid swelling, particularly in cases of unexplained swelling with rapid onset.

Non-occupational recurrent bilateral pneumoparotitis in an adolescent

This is a case report of recurrent bilateral parotid swelling with intraglandular gaseous bubbles in a 14-year-old boy, together with a review of the literature on this condition, which is usually called pneumoparotitis. The disorder has been reported as an occupational hazard in wind instrument players and glass-blowers and also as a rare non-occupational disease, mainly in adolescents and often associated with psychological problems.

Pneumoparotitis

Pneumoparotitis is a rare cause of parotid enlargement. It is due to a reflux of air through Stensen's duct into the acini of the parotid gland with subsequent dilatation. We report a case which followed a long history of autoinflation of the middle ears by the Valsalva manoeuvre. The plain radiographic, sialographic and ultrasound findings are presented.

Pneumoparotis, an unusual occurrence of parotid gland swelling during dental treatment. Report of a case with a review of the literature

A 24-year-old male with pneumoparotis caused by the use of an air syringe during a routine restorative dental procedure during clinical training is presented. Reflux of air into the parotid gland due to increasing pressure is a rare cause of acute parotid swelling.--A discussion of this unusual case and review of the literature including its differential diagnosis and management form the basis of this report. Judicious use of intra-oral dental instruments using compressed air or gas is advised.