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A man in his 30s presented to an outside emergency department with left-sided otalgia and periauricular swelling. He was discharged after being prescribed oral antibiotics but continued to have worsening symptoms and returned to the outside facility, where a noncontrasted computed tomographic (CT) scan of the neck and chest showed significant subcutaneous emphysema of the neck and mediastinum (Figure, A and B). He was subsequently transferred to our facility for additional treatment.
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Pneumoparotid is characterized by retrograde movement of air through the parotid duct, or Stensen duct, into proximal structures of the parotid gland owing to increased intraoral pressures. Simultaneous parotid inflammation or infection by oral bacteria produces pneumoparotitis. Dissection of air through the parotid capsule can produce subcutaneous emphysema of the head and neck.1 Given its rarity, descriptions of pneumoparotitis and its treatments are limited to case reports and series, which include patients with unilateral or bilateral pneumoparotid from behavioral and iatrogenic causes.2 It occurs in patients who habitually expire against a closed or resisted oral aperture, such as wind instrumentalists and glass blowers.1,3 Multiple cases have been documented in children with psychiatric disorders.4 It has also been described from use of compressed air during dental procedures and positive pressure associated with anesthesia.2,5
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Corresponding Author: Paige Egan Bundrick, MD, Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Shreveport, 1501 Kings Hwy 9-203, Shreveport, LA 71103 (firstname.lastname@example.org).
Published Online: January 23, 2020. doi:10.1001/jamaoto.2019.4456
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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