Bilateral parotitis in a patient under continuous positive airway pressure treatment

Abstract

Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis.

Development of acute parotitis after non-invasive ventilation

“…Four previous patients have been described as developing acute parotitis associated with NIV (7-10), including one treated with CPAP (8). Our case appears to report the shortest duration (8 hours) of NIV prior to the development of acute parotitis.…”

“…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.…”

Pneumoparotitis as a complication of long‐term oronasal positive airway pressure for sleep apnea

“…Pneumoparotitis has been previously reported with various activities that increase intraoral pressures, such as glass blowing, playing wind instruments, exercising, and self‐induced behaviors often linked to psychiatric comorbidities . Iatrogenic pneumoparotid has been seen as a complication of spirometry, dental procedures, fine‐needle aspiration of the parotid gland, and positive pressure ventilation used perioperatively or in the intensive care setting commonly referred to as “anesthesia mumps.” Repeated episodes of pneumoparotitis may lead to chronic inflammation, infection, or sialectasis …”

“…Perioperative continuous positive pressure ventilator‐assist devices used after surgery have caused benign, self‐limited “anesthesia mumps,” and have also been implicated in dangerous intracranial insufflation of air resulting in pneumocephalus after sinus surgery . Another case involved bilateral parotitis in a patient treated with short‐term CPAP in the intensive care unit for an exacerbation of chronic obstructive pulmonary disease . We present 2 cases of pneumoparotitis in 2 patients on CPAP therapy for obstructive sleep apnea syndrome: 1 patient with coexisting primary Sjögren syndrome and 1 patient with no previous salivary gland disease.…”