Acute Parotitis as a Complication of Noninvasive Ventilation

Abstract

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.

Development of acute parotitis after non-invasive ventilation

“…Additional reports of this entity will be necessary to discern whether there is indeed a predilection for acute parotitis associated with NIV to occur preferentially on the right side, or whether this is simply a coincidence among a small sample size. The development of acute parotitis due to NIV likely involves positive airway pressure transmitted to the oral cavity causing retrograde air flow and obstruction of the parotid (Stensen) duct (8,9). The initial report of this phenomenon (7) suggested compression of the external parotid duct by the oronasal mask used to deliver NIV, but this seems unlikely as subsequent reports described patients receiving NIV via total face mask as well as via oronasal mask.…”

“…Although the association of acute parotitis with NIV has rarely been reported (7)(8)(9)(10), the escalating use of these modalities may promote an increased incidence of this entity. Thus, intensivists, pulmonologists and other physicians treating patients with acute respiratory failure should be familiar with this possible complication.…”

Parotitis in Children

“…Acute parotitis was reported to develop after noninvasive ventilation. Positive airway pressure transmitted to the oral cavity during noninvasive ventilation causes retrograde airflow and can obstruct the parotid duct [17]. Kawasaki disease might be considered an uncommon cause of nonsuppurative parotitis and might be considered in children with parotitis unresponsive to antibiotics and prolonged fever [18].…”