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Goncalves M, Sievert M, Mantsopoulos K, Schapher ML, Mueller SK, Iro H, Koch M. Pneumoparotid: Practical impact of Surgeon performed Ultrasound in an effective Diagnostic Approach. Oral Dis 2023; 29:3278-3288. [PMID: 35751498 DOI: 10.1111/odi.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/12/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pneumoparotid is characterized by air inclusions in the parotid duct system. Use of ultrasound has proved valuable for evaluating air inclusions in various parts of the body; the diagnostics of this condition has not been systematically analyzed, however. The aim of this study was to evaluate the value of ultrasound in the detection of air inclusions along the parotid duct system and its closer characterization. METHODS Retrospective analysis was carried out of patients diagnosed with pneumoparotid between 2005 and 2020 in a salivary gland center. Ultrasound was performed in all cases, and features of air inclusions were described. Reference standard was the clinical demonstration of foamy saliva after gland massage and/or sialendoscopic evidence of intraductal air inclusions. RESULTS Twenty-one patients were identified (48.8 ± 3.8 years). Two were associated with wind instruments; seven were iatrogenic, following treatment for duct stenosis; one after radiotherapy; four with known bruxism and seven were idiopathic and without associated conditions. On ultrasound examination, pneumoparotid was characterized by three phenomena: flattened, mobile hyperechoic reflexes, dirty shadows with reverberation or "sunbeam effect," and shifting shadows during gland massage. CONCLUSIONS Ultrasound was useful for characterizing pneumoparotid in a fast and practical way and could serve as imaging tool of first choice.
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Affiliation(s)
- Miguel Goncalves
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Rheinische Westfälische Technische Hochschule Aachen, University Hospital, Aachen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Mirco Lothar Schapher
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Sarina Katrin Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
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Yoshida K. Etiology of Pneumoparotid: A Systematic Review. J Clin Med 2022; 12:jcm12010144. [PMID: 36614949 PMCID: PMC9821654 DOI: 10.3390/jcm12010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Gazia F, Freni F, Galletti C, Galletti B, Bruno R, Galletti C, Meduri A, Galletti F. Pneumoparotid and Pneumoparotitis: A Literary Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113936. [PMID: 32498334 PMCID: PMC7313030 DOI: 10.3390/ijerph17113936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Francesco Gazia
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
- Correspondence: ; Tel.: +39-0902212248; Fax: +39-0902212242
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Cosimo Galletti
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Bruno Galletti
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Rocco Bruno
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
| | - Cosimo Galletti
- Comprehensive Dentistry Department, Faculty of Dentistry, Universitat de Barcelona, L’Hospitalet de Llobregat (Barcelona), 08907 Catalonia, Spain;
| | - Alessandro Meduri
- Department of Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Unit of Ophthalmology, University of Messina, 98125 Messina, Italy;
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy; (F.F.); (C.G.); (B.G.); (R.B.); (F.G.)
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Abstract
The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson’s duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.
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Affiliation(s)
- Laura Kathryn House
- Department of Otolaryngology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrea Furr Lewis
- Department of Otolaryngology, University of Mississippi Medical Center, Jackson, MS, USA
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Nicot R, Myon L, Konopnicki S, Ferri J, Raoul G. [Pneumoparotid: a rare cause of recurrent parotid swelling]. ACTA ACUST UNITED AC 2014; 115:111-3. [PMID: 24703198 DOI: 10.1016/j.revsto.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 05/27/2012] [Accepted: 03/11/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pneumoparotid is a rare cause of recurrent parotid swelling. It is often fortuitous, caused by an action inducing intraoral pressure, increased or self-induced. OBSERVATION An 8-year-old boy presented with recurrent right unilateral parotid swelling for 2 years. A CT-scan was performed, outside of the acute phase, which revealed the presence of intraparotid air bubbles. DISCUSSION Pneumoparotitis results from air flowing back into Stensen's duct, due to an anatomical abnormality and a significant increase of intraoral pressure. The diagnosis is made on clinical examination, often completed by a morphological examination (cervicofacial CT-scan or parotid ultrasound investigation). The outcome is most often favorable, with symptomatic treatment, and sometimes antibiotic prophylaxis. Patient education is the best means to prevent recurrence.
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Affiliation(s)
- R Nicot
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille Nord de France, UDSL, 59000 Lille, France.
| | - L Myon
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille Nord de France, UDSL, 59000 Lille, France
| | - S Konopnicki
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille Nord de France, UDSL, 59000 Lille, France
| | - J Ferri
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille Nord de France, UDSL, 59000 Lille, France; Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille, France; International Association of Oral and Maxillofacial Medicine (IAOMM), 7, bis rue de la Créativité, 59650 Villeneuve-d'Ascq, France
| | - G Raoul
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille Nord de France, UDSL, 59000 Lille, France; Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille, France; International Association of Oral and Maxillofacial Medicine (IAOMM), 7, bis rue de la Créativité, 59650 Villeneuve-d'Ascq, France
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Çelebi İ, Öz A, Sasani M, Bayındır P, Sözen E, Vural Ç, Başak M. Using Dynamic Maneuvers in the Computed Tomography/Magnetic Resonance Assessment of Lesions of the Head and Neck. Can Assoc Radiol J 2013; 64:351-7. [DOI: 10.1016/j.carj.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 01/09/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022] Open
Abstract
Despite advances in technology, the radiologic assessment of certain head and neck lesions may still pose difficulties because of the complex anatomy of this region, the small and mobile structures that this region harbors, and the apposition of mucosal surfaces in the neutral position. Certain maneuvers have been described in the literature to overcome these difficulties. We review the use of the Valsalva and the modified Valsalva maneuver, the puffed-cheek technique, phonation, and inspiration, with possible applications in head and neck imaging.
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Affiliation(s)
- İrfan Çelebi
- Radiology Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Aysel Öz
- Radiology Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Clinic, VKV American Hospital, İstanbul, Turkey
| | - Petek Bayındır
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Esra Sözen
- Otorhinolaryngologic Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Çetin Vural
- Department of Otolaryngology, Head and Neck Surgery, Maltepe University School of Medicine, İstanbul, Turkey
| | - Muzaffer Başak
- Radiology Clinic, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
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Is it fluid or air causing anesthesia mumps? J Anesth 2012; 26:638-9. [DOI: 10.1007/s00540-012-1387-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
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McGreevy AE, O'Kane AM, McCaul D, Basha SI. Pneumoparotitis: a case report. Head Neck 2012; 35:E55-9. [PMID: 22431013 DOI: 10.1002/hed.21873] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2011] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Angela E McGreevy
- ENT Department, Craigavon Area Hospital, Portadown, Northern Ireland.
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