Is it fluid or air causing anesthesia mumps?

Etiology of Pneumoparotid: A Systematic Review

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.

Acute Parotitis as a Complication of Noninvasive Ventilation

Several conditions, including oropharyngeal dryness, pressure sores, ocular irritation, epistaxis, or gastric distension, have been described during noninvasive ventilation (NIV). Although this technique has been widely used in intensive care units and emergency wards, acute swelling of the parotid gland remains a scarcely reported complication. We describe herein the case of an 82-year-old man who developed unilateral parotitis during prolonged NIV for acute heart failure. Intravenous antibiotics, corticosteroids, and adjusting the mask laces’ position allowed rapid resolution of clinical symptoms.

Parotitis after epidural anesthesia in plastic surgery: report of three cases

BACKGROUND

Acute swelling of the parotid glands after general anesthesia has become known as anesthesia mumps. Its cause is unknown. Only one case of postsurgical parotitis without general anesthesia is reported. This report describes three cases in this setting after plastic surgery.

CASE 1

A 37-year-old women underwent breast surgery and abdominoplasty with a dual thoracic/lumbar epidural block (bupivacaine 0.5 %). The operative time totaled almost 6 h. Subsequently, 4 h after surgery, the patient experienced painless bilateral parotid swelling without palpable crepitus. The edema resolved completely within 12 h under clinical observation and parenteral hydration.

CASE 2

A 45-year-old patient received subglandular breast implants and body contouring with liposuction, all with the patient under a dual thoracic/lumbar epidural block with 0.5 % marcaine. The total surgical time was 5 h. Subsequently, 3 h after surgery, the patient experienced a similar clinical presentation. The problem resolved completely in 36 h with clinical observation and parenteral hydration. CASE 3: A 30-year-old patient received a subglandular breast implant and underwent liposuction of the outer thighs using a dual thoracic/lumbar epidural block with lidocaine 1 %. The duration of surgery was 1 h. Subsequently, 5 h postoperatively, the patient experienced a similar clinical presentation. Dexamethasone and parenteral hydration were administered. The problem resolved completely in 48 h without sequelae.

CONCLUSIONS

The occurrence of parotitis in patients undergoing surgery under epidural anesthesia is a novel situation, which increases the range of possible etiologies for this little known condition. Dehydration leading to transient parotid secretion obstruction may play a significant role. Further reports of parotitis occurring in the regional anesthesia setting are expected to help elucidate its pathophysiology.

LEVEL OF EVIDENCE IV

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