 |
|
|
|
|
|
|
|
|
|
|
|
 |
 |
 |
 |
 |
|
 |
SALIVARY GLANDS -- PNEUMOPAROTID JULY 1998 Parotid swellings may result from numerous conditions. Infection, obstruction, neoplasms, sarcoid, HIV, drug toxicity and manifestations of alcoholism, diabetes and malnutritional syndromes have all been implicated. Another cause is the forced retrograde pneumatic inflation of the ductal system - pneumoparotid. This entity was first recognized when goldbricking* French foreign legionnaires created factitious cases of mumps by forcefully blowing into a small rigid container. The Salivary Gland Center (SGC) has seen reflux forcing of air through the parotid duct orifice in wind instrument players, glass blowers, and persons who increase their intraoral pressure by blowing up their cheeks consciously or as a neurotic habit or tic. Such habits may have emotional overtones. The anatomic design of the parotid duct orifice as it exits on its papilla usually discourages such air reflux. Regardless, following a stormy general anesthetic with excessive patient coughing and sneezing, and the use of muscle relaxants such as succinylcholine, a condition called "anesthesia mumps" can develop. The increased oral air pressure from the coughing and sneezing, combined with loss of muscle tone, facilitates a transient pneumoparotid.
Chronic infection and its associated symptomatology must be considered as inevitable sequela of the long-term penetration of air into the ducts. With the symptoms of chronic infection superimposed upon the pneumoparotid, a prolonged somewhat painful enlargement is caused by the developing parotitis. Changes in the ductal sialographic pattern will reflect the infection. Dilations and stricturing ("sausaging") result. Because the continued trauma by forced entry of air into the gland leads to infection, autoinsufflation should be stopped. However, this may be difficult to accomplish because the problem often represents an unconscious habit or occupational necessity. Treatment involves counseling and measures aimed at the problem of chronic infection antibiotics, irrigations, duct dilation, duct obliteration, or in advanced cases gland removal. * Add to your vocabulary. Military term for slacker. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982
|
The
parotid swelling can be unilateral or less frequently bilateral.
It will spontaneously subside but it is accompanied by a sense of
fullness or slight discomfort. Palpation of the swelling demonstrates
the classic crackling sensation associated with any facial tissue
emphysema. Viewing of the parotid orifice intraorally, as the gland
is pressed extraorally, reveals the escape of the pathognomonic
frothy and bubbly aerated saliva. This unique and key feature is
a reflection of the forced mixture of air with the saliva contained
within the limiting confines of the ductal system.