耳下腺気腫の2症例

耳下腺腫脹は臨床でしばしば遭遇する症状であり,原因となる病態は様々あるが,稀な疾患として耳下腺気腫がある.耳下腺気腫とは口腔内圧上昇によりステノン管から逆行性に空気が迷入し耳下腺腫大をきたす病態である.今回我々は耳下腺気腫の2症例を経験したので報告する.1症例目は6才男児で左耳下部の疼痛,腫脹を反復したため小児科から紹介.左耳下腺の圧迫でステノン管開口部から泡沫状唾液の流出があり,CT 検査でステノン管内に空気像を認め,左耳下腺気腫と診断された.経過中に頬を膨らませる習癖が確認され,習癖の禁止と抗菌薬処方で保存的に改善した.2症例目は43歳女性で左耳下部の腫脹と疼痛を主訴に当科を紹介受診.画像検査にて迷入した空気によるステノン管拡張と耳下腺内の空気像を認めたため,左耳下腺気腫と診断された.明らかな誘因は確認できず,抗菌薬処方で保存的に改善した.耳下腺腫脹には様々な原因が挙げられ,日常診療でも散見される症状である.急性発症で感染が疑われる場合には,抗菌薬投与で経過観察され軽快している症例も多数存在すると思われる.上述の経過観察とされる症例中にも耳下腺気腫である症例がいくつか含まれている可能性が示唆された.Parotid gland swelling is a familiar symptom in clinical practice and is caused by many conditions. However, swelling from pneumoparotitis is relatively rare. In pneumoparotitis, there is insufflation of air or gas in the retrograde direction up Stensen\u27s duct due to a rise in intraoral pressure. Here, we report two cases of pneumoparotitis. In Case 1, a 6-year-old boy was referred from the pediatrics department of our hospital because of recurrent swelling and pain in the left parotid region. Bubbles were seen in the saliva that discharged from Stensen\u27s duct by pressing the left parotid gland. In the bloodanalysis, serum amylase level was increased without an elevation of the white blood cell count and CRP. Computed tomography showed air in Stensen\u27s duct, and the diagnosis of pneumoparotitis of the left parotid gland was made. During follow-up, we found he had a habit of blowing his cheeks. The pneumoparotitis resolved after his habit was stopped and administration of antibiotics. In Case 2, a 43-year-old woman was referred to our hospital because of swelling and pain in the left parotid region. Blood analysis showed elevation of serum amylase without clear signs of infection. Radiologic evaluation demonstrated enlargement of Stensen\u27s duct due to retrograde passage of air and emphysema in the left parotid gland. The condition was diagnosed as pneumoparotitis of the left parotid gland. We were unable to identify a cause in this case. Symptoms were alleviated after the administration of antibiotics. Many diseases cause parotid gland swelling. We often encounter this symptom in clinical practice. In cases where infection of the parotid gland was suspected from the acute onset of symptoms, it seems that administration of antibiotics and follow-up were conducted without a thorough examination. Our findings suggest that pneumoparotitis may have occurred in some of these cases