Abstract
Parotid swelling in a child can represent any of a variety of pathologies, including lymphadenitis, autoimmune disorders, other inflammatory conditions, vascular malformations, or neoplasms. Parotitis is usually infectious in etiology and is generally treated with antibiotics and supportive management. We report a case of a child with recurrent idiopathic pneumoparotitis, and a review of literature and the disease process is provided.
1
Introduction
Idiopathic recurrent pneumoparotitis is a rare clinical entity that mimics recurrent infectious parotitis, presenting with symptoms of swelling and pain. It is commonly seen in patients who play wind instruments or those with repeated Valsalva maneuvers. It has also been reported in children, primarily adolescents with psychosocial problems. Computed tomography (CT) imaging during an acute episode is diagnostic. Treatment is generally supportive management, with surgical therapy reserved for more severe cases.
2
Case history
A seven-year old boy presented to the Pediatric Otolaryngology Clinic at the Children’s National Medical Center with a 4-year history of intermittent cheek swelling. This swelling was very tender and he had been treated with multiple courses of antibiotics with only transient resolution. Nonsteroidal anti-inflammatory medications had provided pain relief until the swelling has subsided. There was no history of preceding trauma or infection. No other precipitating cause or related factor could be identified.
Physical examination revealed a well-nourished young male with bilateral tender swelling of the parotid areas. Cranial nerve VII function was intact and symmetric. He had limited jaw excursion because of pain and discomfort. No stone was palpated intraorally and both Stenson’s ducts were productive of saliva. The remainder of his physical examination was unremarkable. His past medical history is significant for G6PD deficiency, mild obstructive sleep apnea, allergic rhinitis, and a seizure disorder for which he takes oxcarbazepine.
During one acute episode of painful bilateral parotid swelling, a computed tomography scan with intravenous contrast was obtained. Cystic air-filled dilations were identified within the parotid glandular tissue ( Figs. 1 and 2 ).
He has thus far been managed successfully with conservative measures, including warm compresses, anti-inflammatory medications, and sialogogues. Given the frequency of his attacks, surgical therapy is being considered at this point, including superficial parotidectomy and/or ductal ligation.
2
Case history
A seven-year old boy presented to the Pediatric Otolaryngology Clinic at the Children’s National Medical Center with a 4-year history of intermittent cheek swelling. This swelling was very tender and he had been treated with multiple courses of antibiotics with only transient resolution. Nonsteroidal anti-inflammatory medications had provided pain relief until the swelling has subsided. There was no history of preceding trauma or infection. No other precipitating cause or related factor could be identified.
Physical examination revealed a well-nourished young male with bilateral tender swelling of the parotid areas. Cranial nerve VII function was intact and symmetric. He had limited jaw excursion because of pain and discomfort. No stone was palpated intraorally and both Stenson’s ducts were productive of saliva. The remainder of his physical examination was unremarkable. His past medical history is significant for G6PD deficiency, mild obstructive sleep apnea, allergic rhinitis, and a seizure disorder for which he takes oxcarbazepine.
During one acute episode of painful bilateral parotid swelling, a computed tomography scan with intravenous contrast was obtained. Cystic air-filled dilations were identified within the parotid glandular tissue ( Figs. 1 and 2 ).
