Pneumoparotitis associated with the use of an air-powder prophylaxis unit

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 as a complication of long-term oronasal positive airway pressure for sleep apnea

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.

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.

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.

Subgingival debridement efficacy of glycine powder air polishing

BACKGROUND

Glycine powder air polishing (GPAP) has been shown to be significantly more effective in reducing the subgingival cultivable microflora in shallow periodontal pockets compared to curets and is safe when applied directly to root surfaces. The purpose of this study was to assess the subgingival debridement efficacy of GPAP in periodontal pockets with various depths.

METHODS

In each of 60 patients with severe periodontitis, one tooth with a probing depth (PD) > or =6 mm was randomly assigned to one of the following interventions: GPAP performed in teeth instrumented 3 months earlier (I); GPAP performed in previously non-instrumented teeth (NI); or no treatment (control). GPAP was performed for 5 seconds per surface. After extraction, teeth were stained with 0.5% toluidine blue, and subgingival debridement efficacy was assessed.

RESULTS

Overall, median debridement depth was 2.00 mm in I teeth and 1.86 mm in NI teeth, and the median debrided root surface was 49.24% and 45.64%, respectively. In anatomic PDs (APDs) of 2 to 3 mm, relative debridement depth (debridement depth/APD) ranged from 65% to 80% and 60% to 75% in I and NI teeth, respectively; the corresponding values for debrided root surface were 60% to 70% and 50% to 60%. In control teeth, virtually all subgingival root surfaces were stained. Clinical PD measurements were a median of 1.05 mm deeper than APD.

CONCLUSION

GPAP for 5 seconds per surface is effective in removing most of the subgingival biofilm in periodontal pockets with an APD < or =3 mm.

Implant surface preparation in the surgical treatment of experimental peri-implantitis with autogenous bone graft and ePTFE membrane in cynomolgus monkeys

The aim of the present investigation was to assess the effect of four implant surface preparation methods used in the surgical treatment of experimental peri-implantitis with autogenous bone graft and expanded polytetrafluoroethylene (ePTFE) membrane. The methods were air-powder abrasive unit+citric acid, air-powder abrasive unit, gauze soaked in saline+citric acid, and gauze soaked alternately in chlorhexidine and saline. A total of 64 implants with a titanium plasma-sprayed (TPS) surface was placed in eight cynomolgus monkeys (Macaca fascicularis). After a 3-month period with plaque control, experimental peri-implantitis was induced. A bone loss of 4-6 mm was established after 9-17 months and plaque control was re-implemented. The peri-implantitis defects were surgically exposed, granulation tissue was removed, and each implant surface was prepared by one of the above-mentioned procedures. The defects were then filled with autogenous bone graft particles and covered by an ePTFE membrane. The animals were sacrificed after 6 months. Evaluation by clinical parameters, radiography including quantitative digital subtraction radiography, histology, and stereology did not reveal significant differences between the methods. Almost total bone regeneration and considerable re-osseointegration were obtained irrespective of the method applied. A mean bone-to-implant contact of 39-46% was observed within the defects. Therefore, the present study of implants with a TPS surface in cynomolgus monkeys indicates that the simplest method involving gauze soaked alternately in chlorhexidine and saline should be the preferred implant surface preparation method in the surgical treatment of peri-implantitis involving autogenous bone graft and ePTFE membrane.

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.

Peri-implant tissue response to pathological insults

With the increased use of osseointegrated implants and with many implants functioning for long periods of time, the soft tissue barrier around implants has become more important. This paper reviews the soft tissue response around implants under healthy and diseased conditions and presents the etiology of peri-implant tissue breakdown. Diagnostic techniques such as probing pocket depth, radiographic evidence, and microbial sampling have been analyzed and modified from the periodontal field and used during the maintenance phase of the dental implant. The long-term goal of implant maintenance is to prevent or to arrest the progression of disease, and to achieve a maintainable implant site. Recent reports indicate that peri-implant tissues can be treated with either non-surgical or surgical techniques.

In vitro studies on the effect of cleaning methods on different implant surfaces

The effect of specific cleaning procedures was examined on the surfaces of 3 implant types with different coatings and shapes (plasma sprayed [PS]; hydroxyapatite coated [HA] implants; and smooth titanium surface screws) using a scanning electron microscope. Each implant was treated for 60 seconds per instrument with one of 6 different hygiene measures: plastic curet, metal curet, diamond polishing device, ultrasonic scaler, air-powder-water spray with sodium hydrocarbonate solution, and chlorhexidine 0.1% solution rinse. The air-powder-abrasive system, chlorhexidine rinse, and curettage with a plastic instrument caused little or no surface damage in all but the hydroxyapatite-coated fixtures. Therefore, these 3 methods were tested to determine their cleaning efficacy in a second clinical study, which did not include the HA-coated fixture. Two implants were placed on the facial aspects of both upper molar regions using individual acrylic plates. Thus, 2 fixtures on each side were examined in each patient. The examination revealed that only the sodium hydrocarbonate spray yielded a clean fixture without damage to the implant surface. In a third stage, which imitated the clinical procedure of the second approach, the cell growth of mouse-fibroblasts on implant surfaces was examined after cleaning the surface with plastic scaler and the air-abrasive system, which represents the least damaging and most effective methods. In contrast to the implant surfaces treated with plastic scalers, mostly vital cells were found on implants sprayed with the air-abrasive system.

In vitro analysis of the effects of two air-abrasive prophylaxis systems and inlet air pressure on the surface of titanium abutment cylinders

PURPOSE

The purpose of this study was to investigate the effects of two air-abrasive prophylaxis systems and the effect of inlet air pressure on the surface of Brånemark titanium abutment cylinders.

MATERIALS AND METHODS

Single abutment cylinders were treated with either the Prophy-Jet system (sodium bicarbonate abrasive) (Dentsply International, York, PA) or the Microprophy system (aluminum oxide abrasive) (Danville Engineering Co, Danville, CA) for 60 seconds at an inlet air pressure of 60 psi or 90 psi. The effects on the surface of each abutment cylinder were visually inspected by scanning electron microscopy.

RESULTS

A comparison of abutment cylinder surfaces after treatment showed that the Prophy-Jet system removed machining marks to a greater degree than the Microprophy system. Sodium bicarbonate particles from the Prophy-Jet system were significantly larger than the aluminum oxide particles used with the Microprophy system, potentially accounting for the difference in abrasivity. In addition, inlet air pressure of 60 psi caused removal of machining marks to a greater degree than an inlet air pressure of 90 psi. The principle of phase separation may account for the lower inlet air pressure causing more removal of machining marks than the higher inlet air pressure.

CONCLUSIONS

Under the experimental conditions tested, neither of the two systems tested seemed to cause significant abrasion of the surface of titanium abutment cylinders.

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.