Pneumoparotid causing subcutaneous emphysema secondary to chronic habitual valsalva behaviours in a 13-year-old girl

Pneumoparotid is an unusual condition involving retrograde insufflation of air via the mouth into the parotid gland. In rare circumstances it can be complicated by subcutaneous emphysema. We describe a highly unusual case of rapid-onset facial swelling and limited eye-opening in an otherwise clinically well 13-year-old female. Computed tomography imaging showed pneumoparotid and extensive surgical emphysema involving the cervicofacial soft tissues and mediastinum. A detailed history revealed habitual Valsalva-related behaviours, including ear-popping and blowing bubbles in drinks. She was diagnosed with subcutaneous emphysema secondary to pneumoparotid, and her symptoms resolved with conservative management.