Conservative management of bilateral pneumoparotitis with sialendoscopy and steroid irrigation

Abstract

Pneumoparotitis is a rare condition related to retrograde airflow into the ductal system of the gland and secondary infections. Although counselling is enough in the majority of cases, persistent problems require surgery. Sialendoscopy and ductal irrigation with steroids have never been described as a treatment option. We present the case of a 61-year-old man with recurrent bilateral parotid swellings who had three episodes of sialadenitis on the right side within 2 years. Massage of the glands revealed air bubbles coming out from both papillae. A previous CT scan confirmed the presence of air in both parotid glands. The patient underwent sialendoscopy and irrigation of the ductal system with prednisolone. Ductal irrigation with steroids in three additional sessions led to a significant improvement of symptoms 6 months later. Sialendoscopy and irrigation with steroids could be another treatment modality in cases of recurrent pneumoparotitis avoiding major surgery.

Pneumoparotid and Pneumoparotitis: A Literary Review

“…This pathology usually occurred due no physiological stagnation of air in parotid parenchyma. Pneumoparotid is usually associated with a retrograde insufflation of air and saliva via Stensen's duct into the secondary ducts and glandular acini [40]. Hypotonia of the buccinator muscle, hypertrophy of the masseter muscle or temporary obstruction of the Stensen's duct by mucous are described as possible risk factors [1].…”

“…In recent last years, sialendoscopy has become a good routine technique and minimally invasive diagnostic procedure of the parotid gland. The main goal is the evaluation and management of the salivary ductal system [40]. Currently, CT is the gold-standard technique because it defines anatomy and it is not invasive.Describing air-filled dilatation of Stensen's duct, glandular acini air dilatation, collections, free air intraparenchymal and a good imaging of duct glandular system, also helps in diagnoses of extension of air-accumulation in the nearest areas of the head-neck district [2].…”

Sialendoscopy in the Management of Radioiodine Induced Sialadenitis: A Systematic Review

“…Furthermore, the working channels of the sialendoscope can be used for irrigation of saline or administration of medications, such as topical steroids. 5,6 As identification of cost-conscious practices and minimally invasive undertakings have taken on special importance in our current health care environment, sialendoscopy has been explored as a therapeutic alternative to observation and invasive surgery (ie, gland removal) among patients who do not respond to conservative measures. Consequently, several groups have evaluated its utility in patients who have radioiodide induced salivary dysfunction.…”

Etiology of Pneumoparotid: A Systematic Review

“…Psychiatric treatment was required in 14 patients [11,12,15,17,39,40,48,56,57,67,68,73,96,120]. The surgical procedures included aspiration [1,26,39,46,66,104,110,121], parotidectomy [14,15,40,90], rerouting [4,24,25,61], incision [8,39], ductal ligation [58,71], cystectomy [59,112], and irrigation [95,115]. In addition, continuous positive airway pressure (CPAP) [102,108] and oral appliances [125] were applied to patients with pneumoparotid related to sleep apnea syndrome.…”

“…Sialography remains the standard method for demonstrating sialectasia, radiolucent calculi, duct strictures, and inflammatory diseases of the salivary gland duct system, including duct dilation starting in the parotid duct and the secondary ducts [60]. Sialendoscopy is a routine diagnostic and minimally invasive therapeutic procedure that aims to evaluate and manage salivary ductal system disorders, including chronic inflammatory conditions [95]. High-resolution magnetic resonance imaging using a surface coil and magnetic resonance sialography can be a beneficial diagnostic tool, which is painless and avoids radiation exposure [49].…”