Spontaneous pneumomediastinum is an uncommon clinical form of pneumomediastinum with no relationship to trauma or surgical procedures. Head and neck manifestations are predominant and may be confused with symptoms of acute parotitis. We report a case of spontaneous pneumome-diastinum mimicking bilateral parotitis in a 23-year-old male patient. The symptoms and findings, swelling, and pain, secondary to air passing through the deep fascial planes in the head and neck region, were dominant at the beginning of clinical history. The aim of this case report was to outline the risk of misdiagnosing spontaneous pneumomediastinum as an acute parotitis.