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 (Stenson) duct resulting in inflation of the duct.

Signs and symptoms

The size of the swelling is variable, but it is soft[3] and can occur on one side or both sides.[1] It is typically non tender,[3] 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.[4]

Causes

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

Diagnosis and management

Pneumoparotitis is often misdiagnosed and incorrectly managed.[4] 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 the condition.[1]

Prognosis

Recurrent pneumoparotitis may predispose to sialectasis, recurrent parotitis, and subcutaneous emphysema[4] of the face and neck, and mediastinum, and potentially pneumothorax.[1]

Epidemiology

The condition is rare.[4] It is more likely to occur in persons who regularly have raised pressure in the mouth, for example wind instrument players,[5] and balloon[1] and glass-blowers.[6] Cases have also been reported with bycycle 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.[6][7]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 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. ↑ 2.0 2.1 2.2 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 1-4557-7171-6.
  3. ↑ 3.0 3.1 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.
  4. ↑ 4.0 4.1 4.2 4.3 Goguen, LA; April, MM; Karmody, CS; Carter, BL (December 1995). "Self-induced pneumoparotitis.". Archives of otolaryngology--head & neck surgery 121 (12): 1426–9. PMID 7488376.
  5. ↑ 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. PMID 18075966.
  6. ↑ 6.0 6.1 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. PMID 1624898.
  7. ↑ 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. PMID 3325441.