Head-neck and mediastinal emphysema caused by playing a wind instrument

Abstract

Etiology of head-and-neck emphysema is mainly infectious (cellulitis) or traumatic (rupture of the aerodigestive tract mucosa, usually in the larynx and trachea). We report a case of head-and-neck and mediastinal emphysema due to oral hyperpressure inducing parotid acini rupture. The aim is to highlight the importance of precise interview of patient and family so as to identify this mechanism. Pneumoparotid is a rare cause of swelling induced by insufflation into Stensen's duct. This reflux is caused by intra-oral hyperpressure, and can cause extensive subcutaneous emphysema induced by capsule rupture. The disorder is common in players of wind instruments and glass-blowers. Positive diagnosis is based on focused interview, looking for trigger factors, and on imaging assessment. Evolution is reported to be spontaneously favorable with simple antibiotherapy. Patient education is the best means of limiting recurrence. In case of cervical emphysema, it is important to determine the mechanism of onset and explore for pneumoparotid on CT, so as to adapt treatment and prevent possible recurrence.