Pneumoparotid related to obstructive sleep apnea syndrome treated by oral appliance with anterior opening to reduce intraoral pressure

Abstract

Pneumoparotid is associated with retrograde air insufflation in Stensen's duct and the parotid gland. A 57-year-old man experienced swelling and pain in the right parotid region after sleeping during a flight. Pneumoparotid and obstructive sleep apnea syndrome were diagnosed. Pneumoparotid was suspected as caused by increased intraoral pressure during sleep; thus, an oral appliance to reduce intraoral pressure was effective. After 9 years, the symptoms recurred on the left side. The appliance was reinserted and helped substantially. This is the first case report of obstructive sleep apnea syndrome accompanying pneumoparotid, treated effectively with an oral appliance, with a 10-year follow-up.

Keywords: obstructive sleep apnea syndrome; oral appliance therapy; parotid gland; parotid swelling; pneumoparotid.

FIGURE 1

Air bubbles from the orifice of Stensen's duct

FIGURE 2

Axial sections of a CT scan show air in both parotid glands and ducts at first visit (A) and 9 years later (B). Air in the parotid glands or ducts (arrows)

FIGURE 3

Hichiriki (A) is a traditional Japanese wind instrument with 1400 years of history. The patient playing the hichiriki (B)

FIGURE 4

Oral appliance to reduce intraoral pressure in place