Pneumoparotitis

Pneumoparotitis (also termed pneumosialadenitis[1] wind parotitis,[1] surgical mumps,[2] or anaesthesia mumps),[2] is a rare cause of parotid gland swelling which occurs when air is forced through the parotid (Stensen) duct resulting in inflation of the duct.[3]

Signs and symptoms

The size of the swelling is variable, but it is soft[4] and can occur on one side or both sides.[1] It is typically non tender,[4] although sometimes there may be pain.[1] It usually resolves over minutes to hours, however occasionally this may take days.[1] The condition can be transient or recurrent.[5]

Causes

The condition is caused by raised air pressure in the mouth. [1]

Diagnosis and management

Pneumoparotitis is often misdiagnosed and incorrectly managed.[5] The diagnosis is based mainly on the history.[1] Crepitus may be elicited on palpation of the parotid swelling,[1] and massaging the gland may give rise to frothy saliva or air bubbles from the parotid papilla.[1] Further investigations are not typically required, however sialography, ultrasound and computed tomography may all show air in the parotid gland and duct.[1]

Management is simply by avoidance of the activity causing raised intraoral pressure which is triggering this rare condition.[1]

Prognosis

Recurrent pneumoparotitis may predispose to sialectasis, recurrent parotitis, and subcutaneous emphysema[5] of the face and neck, and mediastinum, and potentially pneumothorax.[1]

Epidemiology

The condition is rare.[5] It is more likely to occur in persons who regularly have raised pressure in the mouth, for example wind instrument players,[6] and balloon[1] and glass-blowers.[7] Cases have also been reported with bicycle tyre inflation,[1] whistling,[1] nose blowing,[1] cough[1] and valsalva manoeuvre to clear the ears.[1] It can be an iatrogenic effect of dental treatment,[1] spirometry,[1] and positive pressure ventilation.[2] Apart from these factors, the condition mainly occurs in adolescents, often self-inflicted due to psychological issues.[7][8]

References
  1. Joiner MC; van der Kogel A (15 June 2016). Basic Clinical Radiobiology, Fifth Edition. CRC Press. p. 1908. ISBN 978-0-340-80893-1.
  2. Gibson AM; Benko KR (5 May 2013). Head, Eyes, Ears, Nose, and Throat Emergencies, An Issue of Emergency Medicine Clinics. Elsevier Health Sciences. p. 124. ISBN 978-1-4557-7171-4.
  3. McCormick, Michael E.; Bawa, Gurneet; Shah, Rahul K. (2013). "Idiopathic recurrent pneumoparotitis". American Journal of Otolaryngology. 34 (2): 180–182. doi:10.1016/j.amjoto.2012.11.005. ISSN 0196-0709. PMID 23318047.
  4. Mukherji SK; Chong V (1 January 2011). Atlas of Head and Neck Imaging: The Extracranial Head and Neck. Thieme. p. 147. ISBN 978-1-60406-525-1.
  5. Goguen, LA; April, MM; Karmody, CS; Carter, BL (December 1995). "Self-induced pneumoparotitis". Archives of Otolaryngology–Head & Neck Surgery. 121 (12): 1426–9. doi:10.1001/archotol.1995.01890120082017. PMID 7488376.
  6. Kreuter, M; Kreuter, C; Herth, F (February 2008). "[Pneumological aspects of wind instrument performance--physiological, pathophysiological and therapeutic considerations]". Pneumologie (Stuttgart, Germany). 62 (2): 83–7. doi:10.1055/s-2007-996164. PMID 18075966.
  7. Ferlito, A; Andretta, M; Baldan, M; Candiani, F (June 1992). "Non-occupational recurrent bilateral pneumoparotitis in an adolescent". The Journal of Laryngology and Otology. 106 (6): 558–60. doi:10.1017/s0022215100120146. PMID 1624898.
  8. Markowitz-Spence, L; Brodsky, L; Seidell, G; Stanievich, JF (December 1987). "Self-induced pneumoparotitis in an adolescent. Report of a case and review of the literature". International Journal of Pediatric Otorhinolaryngology. 14 (2–3): 113–21. doi:10.1016/0165-5876(87)90021-8. PMID 3325441.
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