Pneumoparotid and Pneumoparotitis: A Literary Review

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.

Imaging of parotid anomalies in infants and children

“…22 ). In adults, it has been described in glass blowers, wind instrumentalists, divers, after dental instrumentation (braces), in coughing attack or in psychiatric patients [ 66 , 67 ]. In children and teenagers, it has been reported in case of psychosocial issues, the cause of the pneumoparotid being a self-induced disorder, as in psychiatric adult patients.…”

Emphysema of the periorbital region and mediastinum in a young child following a dental procedure

“…1 Mediastinal emphysema may evolve into tamponade and airway compression; the risk of aggressive infections, such as necrotizing fasciitis or mediastinitis, after dental procedures is documented in the literature. 1,2 Anesthesia mumps gives rise to a clinical pattern similar to that of iatrogenic pneumoparotitis. The mechanism behind anesthesia mumps is not completely understood.…”

Pneumoparotid: a rare but well-documented cause of parotid gland swelling

“…Recurrent parotid insufflation may predispose to sialectasis; recurrent parotitis; and subcutaneous emphysema of the face, neck, and mediastinum; and subsequent pneumothorax [2].…”

“…People at risk of developing occupational pneumoparotid can be taught techniques to reduce their chances of insufflation. In case of selfinduction, reassurance and psychological counseling are often required [2]. Surgical interventions including Stensen's duct ligation, transposition of the Stensen's duct to the tonsillar fossa, and parotidectomy [6,10] can be considered for recurrent pneumoparotid associated with sialectasis and recurrent parotitis not responding to conservative measures.…”

“…Pneumoparotid is a rare cause of parotid gland swelling. It describes the presence of air within the duct system and/or parenchyma of the parotid gland secondary to its reflux through Stensen's duct [1,2].…”