Introduction
Swelling or pain in the parotid region is a relatively common complaint
in clinical practice of internal medicine, otolaryngology, and oral and
maxillofacial surgery. There are many causes of parotid gland swelling,
such as inflammation, viral infection, sialoliths, benign or malignant
tumors, autoimmune diseases, and endocrine disorders. The pneumoparotid
is one of the causes of parotid gland swelling, which refers to the
retrograde insufflation of air inside the parotid gland or Stensen’s
duct. The pneumoparotid was first described by Hyrtl1in 1865 in wind instrument players. Moreover, until the first half of
the 20th century, the pneumoparotid has been recognized as a typical
occupational disease in glass blowers.2-4 However, the
other etiologies of the pneumoparotid are variable and include
self-induction, 5-11 abnormal
habit,12-14 coughing attack,15-17nervous tic,5, 18, 19 iatrogenic causes such as dental
treatment,19-21 continuous positive
pressure23, 24 and spirometry.25
Obstructive sleep apnea is a disorder characterized by repetitive,
complete, or partial closure of the upper airway during
sleep.26 Sleep apnea is defined as 30 or more apneic
episodes (cessation of airflow at the mouth and nose for more than 10
s).26-29 Typical subjective complaints of sleep apnea
are excessive daytime sleepiness, loud and irregular snoring, disturbed
nighttime sleep, mental deterioration and
depression.30, 31 A recent systematic review
highlighted that the overall prevalence of obstructive sleep apnea
ranged from 9% to 38% in the general adult
population.32 Patients with this condition are at an
increased risk of automobile accidents.33, 34 It is
associated with an increased prevalence of cardiovascular complications,
such as arterial hypertension,35, 36 coronary artery
disease,37 and nocturnal angina.38
Continuous positive airway pressure is an effective treatment option.
However, problems associated with its use leading to non-compliance
include nasal congestion, discomfort secondary to pressure sensation and
air leak, and mask intolerance.30, 31 In 1984,
Meier-Ewert et al.39 first described an oral appliance
for obstructive sleep apnea syndrome. Oral appliances are an important
treatment choice and may be the preferred initial treatment for mild to
moderate obstructive sleep apnea syndrome or snoring.
In this study, we describe a patient with pneumoparotid disease related
to obstructive sleep apnea syndrome and oral appliance therapy.
Plausible relationship between pneumoparotid and sleep apnea syndrome is
discussed.