Pneumoparotid: A Rare Consequence of Being a Saxophonist

A teenage girl who had recently begun playing saxophone presented with recurrent painless right cheek swelling for six months. Despite several courses of antibiotics, the swelling continued to re-occur. On examination, enlargement of the right parotid gland and crepitus over the same region are noted, with no signs of acute inflammation. Ultrasound examination of the right parotid gland revealed linear areas of increased echogenicity with equivocal posterior shadowing. Computed tomography (CT) showed enlargement of the right parotid gland with numerous gas bubbles in Stensen's duct and their branches without any signs of inflammation. Pneumoparotid represents an uncommon etiology of parotid gland enlargement. It is characterized by air infiltration within the parotid duct system and/or gland parenchyma secondary to retrograde air reflux via Stensen's duct. This condition is often seen in situations generating significant intraoral pressure, including activities such as playing wind instruments. Diagnosis relies on clinical examination and is confirmed through diagnostic imaging. Treatment is conservative and predominantly involves warm compresses. However, antibiotics may be prescribed to prevent secondary suppurative parotitis.