Recurrent pneumosialadenitis: A case presentation and new surgical intervention

There are multiple etiologies for facial subcutaneous emphysema, including facial trauma; dissection of air along fascial planes from a pneumomediastinum; infection; and entry of air through defects in teeth due to decay, trauma, or dental procedures. In addition, air can be forced through lacerations of the oral or pharyngeal mucosa by increased intraoral pressures. An infrequently reported cause of subcutaneous emphysema is autoinsufflation of the parotid duct with extravasation of air into the surrounding tissue. Although only two cases have been reported in the American literature, authors in the European literature claim this occurs in 6% to 10% of glass blowers and frequently in musicians who play wind instruments. We report a patient with recurrent pneumosialadenitis that resulted from a patulous parotid duct and was successfully treated by rerouting the parotid duct to the apex of the tonsillar fossa.