Inflating parotids with air: A case of pneumoparotid and review of the literature. A case of pneumoparotid

Pneumoparotid with imaging findings: A case report and review of literature

BACKGROUND

Pneumoparotid is a rare disease associated with retrograde airflow into the ductal system. There is no established treatment for this disease, which has no known complications. Mouth puffing and playing wind instruments are known to be the causes of this disease.

CASE SUMMARY

We managed a case, in which pneumoparotid suddenly recurred 4 months after surgery for purulent parotiditis. The patient did not report any obvious etiological factors, such as mouth puffing or playing a wind instrument. We reviewed 128 articles (from 1941 to 2023) that reported on a total of 166 patients with pneumoparotid, including the patient from the present case report, with imaging findings. This is the first reported case of pneumoparotid following surgery for purulent parotitis. The etiology in our case was classified as idiopathic.

CONCLUSION

Imaging findings could be sufficient for accurate pneumoparotid diagnoses and the exclusion of complications; computed tomography could be useful.

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.