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Goncalves M, Sievert M, Mantsopoulos K, Schapher ML, Mueller SK, Iro H, Koch M. Pneumoparotid: Practical impact of Surgeon performed Ultrasound in an effective Diagnostic Approach. Oral Dis 2023; 29:3278-3288. [PMID: 35751498 DOI: 10.1111/odi.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/12/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pneumoparotid is characterized by air inclusions in the parotid duct system. Use of ultrasound has proved valuable for evaluating air inclusions in various parts of the body; the diagnostics of this condition has not been systematically analyzed, however. The aim of this study was to evaluate the value of ultrasound in the detection of air inclusions along the parotid duct system and its closer characterization. METHODS Retrospective analysis was carried out of patients diagnosed with pneumoparotid between 2005 and 2020 in a salivary gland center. Ultrasound was performed in all cases, and features of air inclusions were described. Reference standard was the clinical demonstration of foamy saliva after gland massage and/or sialendoscopic evidence of intraductal air inclusions. RESULTS Twenty-one patients were identified (48.8 ± 3.8 years). Two were associated with wind instruments; seven were iatrogenic, following treatment for duct stenosis; one after radiotherapy; four with known bruxism and seven were idiopathic and without associated conditions. On ultrasound examination, pneumoparotid was characterized by three phenomena: flattened, mobile hyperechoic reflexes, dirty shadows with reverberation or "sunbeam effect," and shifting shadows during gland massage. CONCLUSIONS Ultrasound was useful for characterizing pneumoparotid in a fast and practical way and could serve as imaging tool of first choice.
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Affiliation(s)
- Miguel Goncalves
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Rheinische Westfälische Technische Hochschule Aachen, University Hospital, Aachen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Mirco Lothar Schapher
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Sarina Katrin Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
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Yoshida K. Etiology of Pneumoparotid: A Systematic Review. J Clin Med 2022; 12:jcm12010144. [PMID: 36614949 PMCID: PMC9821654 DOI: 10.3390/jcm12010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Yoshida K. Pneumoparotid related to obstructive sleep apnea syndrome treated by oral appliance with anterior opening to reduce intraoral pressure. Clin Case Rep 2022; 10:e05816. [PMID: 35592044 PMCID: PMC9097368 DOI: 10.1002/ccr3.5816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery National Hospital Organization Kyoto Medical Center Kyoto Japan
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Gazia F, Freni F, Galletti C, Galletti B, Bruno R, Galletti C, Meduri A, Galletti F. Pneumoparotid and Pneumoparotitis: A Literary Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113936. [PMID: 32498334 PMCID: PMC7313030 DOI: 10.3390/ijerph17113936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Francesco Gazia
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
- Correspondence: ; Tel.: +39-0902212248; Fax: +39-0902212242
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Cosimo Galletti
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Bruno Galletti
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Rocco Bruno
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Cosimo Galletti
- Comprehensive Dentistry Department, Faculty of Dentistry, Universitat de Barcelona, L’Hospitalet de Llobregat (Barcelona), 08907 Catalonia, Spain;
| | - Alessandro Meduri
- Department of Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Unit of Ophthalmology, University of Messina, 98125 Messina, Italy;
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
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Lagunas JG, Fuertes AF. Self-induced parapharyngeal and parotid emphysema: A case of pneumoparotitis. ORAL AND MAXILLOFACIAL SURGERY CASES 2017. [DOI: 10.1016/j.omsc.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Goates AJ, Lee DJ, Maley JE, Lee PC, Hoffman HT. Pneumoparotitis as a complication of long-term oronasal positive airway pressure for sleep apnea. Head Neck 2017; 40:E5-E8. [PMID: 29149468 DOI: 10.1002/hed.25003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/31/2017] [Accepted: 09/26/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Parotid swelling is rarely caused by pneumoparotitis from retrograde insufflation of air into Stensen's duct. Previous reports have identified occupational exposures, self-induced habits, exercise, spirometry, and short-term positive pressure airway ventilation as causes of salivary duct insufflation. METHODS We present 2 cases of pneumoparotitis in patients on long-term oronasal continuous positive airway pressure (CPAP) for obstructive sleep apnea. RESULTS A diagnosis of pneumoparotitis was made by CT scan in case 1 and sialography in case 2. Patients were advised to transition from oronasal to nasal-only CPAP. One patient was successfully transferred and had good symptomatic improvement, whereas the second patient did not tolerate nasal CPAP and had persistent symptoms on oronasal CPAP. CONCLUSION Long-term use of oronasal CPAP is a potential cause of pneumoparotitis.
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Affiliation(s)
- Andrew J Goates
- University of Iowa Carver College of Medicine, Department of Otolaryngology - Head and Neck Surgery, Iowa City, Iowa
| | - Daniel J Lee
- University of Iowa Carver College of Medicine, Department of Otolaryngology - Head and Neck Surgery, Iowa City, Iowa
| | - Joan E Maley
- University of Iowa Carver College of Medicine, Department of Radiology, Iowa City, Iowa
| | | | - Henry T Hoffman
- University of Iowa Carver College of Medicine, Department of Otolaryngology - Head and Neck Surgery, Iowa City, Iowa
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Ahuja CK, Yadav MK, Gupta V, Khandelwal N. Incidental pneumoparotid detected on computed tomography: Should it raise an alarm? Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:792-5. [PMID: 23159118 DOI: 10.1016/j.oooo.2012.08.438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 05/10/2012] [Accepted: 08/07/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pneumoparotid is often seen in patients as a result of infection or following maneuvers that lead to increase in intraoral pressures. We describe a short series of 5 cases of incidental pneumoparotid, for the first time, detected during neck contrast-enhanced computed tomography (CECT) examination. METHODS All neck CECT examinations that had been acquired over a 4-month period for indications other than pertaining to the parotid gland were retrospectively analyzed. RESULTS Four hundred cases were reviewed. Five of 80 patients in whom CECT was acquired after the "puffed cheek" maneuver were detected to have incidental pneumoparotid. All remained clinically asymptomatic during the examination. CONCLUSIONS Pneumoparotid may be an incidental finding in patients asked to blow air in a closed mouth during CT/magnetic resonance acquisition. An awareness of this benign finding would prevent sudden alarm of interpreting it as an anaerobic infection of the parotid in such patients.
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Affiliation(s)
- Chirag Kamal Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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McGreevy AE, O'Kane AM, McCaul D, Basha SI. Pneumoparotitis: a case report. Head Neck 2012; 35:E55-9. [PMID: 22431013 DOI: 10.1002/hed.21873] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2011] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Angela E McGreevy
- ENT Department, Craigavon Area Hospital, Portadown, Northern Ireland.
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9
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Ghanem M, Brown J, McGurk M. Pneumoparotitis: a diagnostic challenge. Int J Oral Maxillofac Surg 2011; 41:774-6. [PMID: 22209185 DOI: 10.1016/j.ijom.2011.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 12/01/2011] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- M Ghanem
- Department of Oral and Maxillofacial Surgery, Nasser Institute Hospital, Cairo, Egypt.
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Hervás Núñez MJ, Benito Navarro JR, Rodríguez Fernández-Freire A, Rodríguez Pérez MA. Parotid Pneumocele in Down's Syndrome. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Neumocele parotídeo en el síndrome de Down. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Martín-Granizo R, Herrera M, García-González D, Mas A. Pneumoparotid in childhood: report of two cases. J Oral Maxillofac Surg 1999; 57:1468-71. [PMID: 10596673 DOI: 10.1016/s0278-2391(99)90737-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Martín-Granizo
- Department of Oral & Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Kirsch CM, Shinn J, Porzio R, Trefelner E, Kagawa FT, Wehner JH, Jensen WA. Pneumoparotid due to spirometry. Chest 1999; 116:1475-8. [PMID: 10559118 DOI: 10.1378/chest.116.5.1475] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
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.
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Affiliation(s)
- C M Kirsch
- Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
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Sittel C, Jungehülsing M, Fischbach R. High-resolution magnetic resonance imaging of recurrent pneumoparotitis. Ann Otol Rhinol Laryngol 1999; 108:816-8. [PMID: 10453793 DOI: 10.1177/000348949910800818] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C Sittel
- Department of Otorhinolaryngology--Head and Neck Surgery, University of Cologne, Germany
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Golz A, Joachims HZ, Netzer A, Westerman ST, Gilbert LM. Pneumoparotitis: diagnosis by computed tomography. Am J Otolaryngol 1999; 20:68-71. [PMID: 9950118 DOI: 10.1016/s0196-0709(99)90055-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Golz
- Department of Otolaryngology-Head & Neck Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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16
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Affiliation(s)
- R E Alcalde
- Department of Oral and Maxillofacial Surgery II, Okayama University Dental School, Japan
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