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

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.

Pneumoparotid related to obstructive sleep apnea syndrome treated by oral appliance with anterior opening to reduce intraoral pressure

Pneumoparotid is associated with retrograde air insufflation in Stensen's duct and the parotid gland. A 57‐year‐old man experienced swelling and pain in the right parotid region after sleeping during a flight. Pneumoparotid and obstructive sleep apnea syndrome were diagnosed. Pneumoparotid was suspected as caused by increased intraoral pressure during sleep; thus, an oral appliance to reduce intraoral pressure was effective. After 9 years, the symptoms recurred on the left side. The appliance was reinserted and helped substantially. This is the first case report of obstructive sleep apnea syndrome accompanying pneumoparotid, treated effectively with an oral appliance, with a 10‐year follow‐up.

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.

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.

Iatrogenic pneumomediastinum with extensive subcutaneous emphysema after endodontic treatment: report of 2 cases

Pneumomediastinum with subcutaneous emphysema is a relatively rare complication of dental treatment. The most common dental etiology of this complication is the introduction of air via the air-turbine handpiece during surgical extraction of an impacted tooth, but this complication is very rare after nonsurgical endodontic treatment. We report herein 2 cases of massive pneumomediastinum and cervicofacial subcutaneous emphysema that developed after opening an access cavity for endodontic retreatment. We describe its etiologies and guidelines for the prevention of this complication during nonsurgical endodontic treatment.

[Subcutaneous cervicofacial and mediastinal emphysema complicating tooth extraction: case report]

Subcutaneous emphysema is a rare and well-known complication of dental procedures. Many cases go unrecognized and resolve spontaneously, while others may require specific surgical management to prevent complications. We present a case of cervicofacial and mediastinal emphysema which occurred during a routine dental procedure and a review of the literature on differential diagnosis and management.

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.

Pneumoparotitis: a new diagnostic technique and a case report

Pneumoparotitis is a rare cause of parotid gland swelling. We report a case of self-induced pneumoparotitis that resulted in subcutaneous emphysema and pneumomediastinum after an open biopsy of the parotid gland. We suggest a new method for diagnosing this condition. This is done by insufflation of the cheeks with contrast in the oral cavity. A reflux of air and contrast is subsequently demonstrated by a computed tomography scan of the area.