Orbital emphysema during air travel: a case report

doi:10.1054/jcms.2002.0321

Journal of Cranio-Maxillofacial Surgery

Volume 30, Issue 6, December 2002, Pages 367-368

https://doi.org/10.1054/jcms.2002.0321 Get rights and content

Abstract

Orbital emphysema is a well-recognized complication of fractures involving the orbit. Commonly, this follows nose blowing and occurs in the subcutaneous tissues. A case of emphysema within the orbital cavity caused by the pressure changes during air travel is presented. The clinical picture was similar to that seen in retrobulbar haemorrhage and required early surgical intervention. Circumstances where patients at risk may be exposed to abnormal atmospheric pressures are highlighted and the management of the condition is discussed.

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Cited by (26)

Subcutaneous emphysema after vigorous sneezing in the setting of acute frontal sinusitis
2017, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Citation Excerpt :
Prior studies have identified a predilection for air to escape via paranasal sinus fractures into the periorbital region due to the looseness of areolar tissue and fragility of the lamina papyracea [13–16]. Subcutaneous emphysema [SCE] of the head has been well documented in the literature as the result of processes including facial trauma [1,2,17,18], dental procedures [19,20], cough [21,22], nose blowing [17,23], sneezing [6,7], air travel [24], and tracheal trauma [25–27]. SCE is produced as air is introduced into fascial planes of the head and neck [28,29], and due to the extensibility of the connective tissue, these collections of air can grow to considerable size [11].
Subcutaneous emphysema [SCE] can develop due to traumatic, infectious, and spontaneous causes and usually localizes to the periorbital space.
We present a case of an 18-year-old male with an 8-day history of migraine-like headaches followed by the acute onset of frontofacial swelling after vigorous sneezing. Radiologic and physical exam findings supported a diagnosis of frontofacial SCE in the setting of frontal sinusitis.
A sneeze, although usually benign, causes a significant increase in intranasal pressure. When coupled with a history significant for facial trauma or rhinosinusitis, this rise in pressure can be sufficient to cause fracturing of the bone overlying a paranasal sinus, leading to the formation of SCE.
A diagnostic challenge of an unusual presentation of pneumomediastinum
2014, Chinese Journal of Traumatology - English Edition
A 77-year-old man who had underwent orthopedic surgery 17 days ago due to his left femur fracture caused by a pedestrian-car accident came to our emergency department with the chief complaint of a 2 days history of sore throat and cough and also swelling of eyelids. He had no respiratory distress or any other life-threatening symptoms. Subsequent physical examination revealed remarkable edema and crepitus over the whole face neck proximal upper limbs and the anterior and posterior chest regions and also bilateral hyperresonance was detected in pulmonary auscultation. The imaging studies showed pneumomediastinum and bilateral subcutaneous emphysema. The diagnosis of pneumomediastinum and mild left pneumothorax and massive subcutaneous emphysema was definitely made. He underwent bilateral tube thoracostomy by using a 32 French chest tube under local anesthesia in the fifth intercostal space on the anterior axillary line. The patient was discharged with no complications 10 days postoperatively.
Pediatric orbital emphysema caused by a compressed-air pistol shot: A case report
2014, Archivos de la Sociedad Espanola de Oftalmologia
Se presenta el caso de un escolar de 2 años con un enfisema orbitario tras disparo con pistola de aire comprimido en la región malar. Se aplicó tratamiento conservador y presentó buena evolución sin complicaciones.
El enfisema orbitario en ausencia de fractura de la pared orbitaria es una entidad muy rara. Normalmente se observa enfisema orbitario asociado a traumatismos que causan fracturas de los senos paranasales o los huesos faciales. En la literatura consultada hay pocos casos de enfisema orbitario secundarios a lesiones producidas por aire comprimido.
We report the case of a 2 year-old child with orbital emphysema secondary to a compressed-air gun shot in the malar region, with no evidence of orbital wall fracture. Conservative treatment was applied, and no complications were observed.
Orbital emphysema in the absence of an orbital wall fracture is a rare situation. Orbital emphysema is usually seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To our knowledge there have been very few reports of orbital emphysema caused by a compressed-air injury.
Flying and midface fractures: The truth is out there
2013, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The patient's symptoms resolved postsurgery.7 In this case, Monaghan and Millar7 postulated that the increased atmospheric pressure during descent forced air from the maxillary sinus into the orbital cavity, and that the fine fracture line did not allow equalization of the tension within the orbit with the maxillary sinus. Orbital emphysema is a well-recognized complication of fractures involving the orbit and is seen on conventional radiographs in two-thirds of patients with orbital fractures.8
There are no clear, evidence-based guidelines that dictate when it is safe for a patient to fly after sustaining a midface fracture. From January 2006 to December 2009, the Royal Darwin Hospital Maxillofacial Unit had 48 out of 201 patients with an orbital fracture that involved a paranasal air sinus transported by a variety of aircraft to the unit for definitive management. No orbital complications were recorded for the 24% of patients requiring air travel to our tertiary referral centre. Furthermore, there were no recorded deviations from the standard flight plan. We believe that this demonstrates there are no absolute contraindications to flying on a variety of aircraft with a midface fracture, but clinical assessment remains crucial for an informed decision to transport these patients by air.
Orbital emphysema - the need for surgical intervention
2008, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
A forced expiratory event followed immediately by proptosis and decreased visual acuity secondary to trauma to the orbit is the important aspect of the history. However, differentiating orbital emphysema from a retrobulbar haemorrhage, prior to radiological investigation can be difficult (Monaghan and Millar, 2002). Retrobulbar haemorrhage, although rare, may also occur following a forced expiratory event secondary to orbital trauma.
Orbital emphysema is a recognised complication of fractures of the orbit and only rarely poses a threat to vision.
We present three patients with threatened vision secondary to orbital emphysema that required an immediate surgical decompression.
Visual function was preserved in all three patients.
Clinical awareness of pneumo-orbitism is vital as immediate orbital decompression may be necessary to preserve visual function.
Air medical evacuation in patients with airleak syndromes
2008, Air Medical Journal

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^f1: Mr. A. M. Monaghan, BDS, MB, ChB, FDSRCS, FRCS. 45 Kingscote Road, Edgbaston, Birmingham, B15 3 LA, UK Tel: +44 0121 454 0820

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Regular ArticleOrbital emphysema during air travel: a case report

Abstract

Ann Emerg Med

Ophthalmology

J Oral Maxillofac Surg

Am J Ophthalmol

Radiology for maxillofacial trauma

Regular Article
Orbital emphysema during air travel: a case report