Barotraumatic Blow-out Fracture of the Medial Orbital Wall by Nose Blowing

Abstract

Blow-out fracture is one of the most common facial bone fractures and mainly caused by blunt trauma, whereas barotraumatic causes are relatively rare. In this report, we present the case of a patient with an orbital medial wall blow out fracture caused by nose blowing. This case is unique in that the barotraumatic blow out fracture occurred in a patient without previous known risk factors, except that she had previously been operated on for orbital floor blow-out fracture. It is possible that barotraumatic orbital medial wall fracture occurred due to postoperative changes in the aerodynamics or shock-absorbing capacity of the paranasal sinuses. To prevent barotraumatic trauma in the orbital wall, patients undergoing surgery for orbital fractures should consider avoiding excessive nose blowing not only in the weeks after surgery, but for a sufficient period of time.

Orbital Defect and Emphysema After Nose Blowing: A Case Report and Literature Review

“…Case reports were excluded if they were related to acute trauma, recent surgery within five years, or lack of a fracture. A total of 17 additional cases met the inclusion and exclusion criteria to review, for a total of 18 cases (Table 1) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. All of the cases involved fractures of either the medial wall [3,5,[7][8][9][10][11][12] or the floor [4,6,[13][14][15][16][17][18][19], which, anatomically, are the thinnest locations of the orbital walls.…”

“…A total of 17 additional cases met the inclusion and exclusion criteria to review, for a total of 18 cases (Table 1) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. All of the cases involved fractures of either the medial wall [3,5,[7][8][9][10][11][12] or the floor [4,6,[13][14][15][16][17][18][19], which, anatomically, are the thinnest locations of the orbital walls. The average age on presentation was 45.2 years old (range: 30 to 76 years).…”

“…The majority of these patients were female (11/18, 61.1%) [2,5,6,[8][9][10]12,13,[15][16][17]. All patients (18/18, 100%) presented with swelling of the eyelids or periorbital region after a noseblowing episode [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Nine cases (9/17, 52.9%) specifically mentioned "strong," "vigorous," or "forceful" nose blowing prior to symptom onset [4][5][6]8,10,12,14,16,18].…”

“…On CT imaging, just over half of the fractures involved the orbital floor (10/18, 55.6%) [4,6,[13][14][15][16][17][18][19]. Altogether, nine patients (9/18, 50.0%) had CT evidence of some degree of herniation of orbital contents [3][4][5][6][8][9][10]13,15] and 17 had documented orbital emphysema (17/18, 94.4%) [3][4][5][6][7][8][9][10][11][12][13][14][15][16]18,19]. Regarding past medical history, five patients (5/18, 27.8%) had no history of facial trauma, facial or nasal surgery, sinusitis, or illness [11,[13][14][15][16].…”

“…Regarding past medical history, five patients (5/18, 27.8%) had no history of facial trauma, facial or nasal surgery, sinusitis, or illness [11,[13][14][15][16]. Prior trauma was documented in two cases (2/18, 11.1%), one of which had been treated with open reduction and internal fixation for an orbital floor blowout fracture six years prior [3], while the other had isolated left-sided facial trauma 10 years prior without fractures [17]. Rhinitis, sinusitis, or seasonal allergies were documented in five patients (5/18, 27.8%) [8,13,14,18].…”