Orbital Emphysema as a Rare Complication of Septorhinoplasty: A Case Report

Abstract

Orbital emphysema following rhinoplasty is an extremely rare complication. Only one case of sub-dermal emphysema was reported in the English literature following rhinoplasty directly in post-operative period and one reported case of sudden orbital emphysema during septorhinoplasty operation. A 29 year old male underwent open septorhinoplasty. Surgery was un eventful and no nasal packs were placed after surgery. Hours after surgery he developed right orbital swelling following forceful nose blowing and sneezing. CT scan showed extensive right orbital and peri-orbital emphysema extending to the right infra-temporal fossa. Emphysema was gradually resolving without any complications and disappeared completely on the 10th day post-operatively.

Acute Diplopia Following Rhinoplasty: Clearing the Air

“…8,17 Orbital and periorbital emphysema are generally nonthreatening conditions that resolve within 1 to 2 weeks. 9,17 Sinus precautions may prevent progression. Antihistamines can reduce mucosal inflammation that may be contributing to ostial obstruction or the sneeze reflex.…”

“…8 Two additional cases of orbital emphysema and 3 cases of palpebral, or subcutaneous periorbital, emphysema after rhinoplasty were identified in the literature. [9][10][11][12][13] None of these patients experienced visual symptoms, though 2 underwent decompression with a lateral canthotomy or percutaneous aspiration. 12,13 All reports suggest the air may have entered through the piriform incision and then tracked along the subperiosteal dissection (Table 1).…”

“…A tear in the orbital septum was implicated in the 3 cases of orbital involvement. 6,9,13 The authors propose that a 1-way valve was created as the surrounding soft tissues collapsed, trapping in the air. Other mechanisms intuitively require some breach of the orbital wall and sinus mucosa, orbital septum, or conjunctiva.…”

“…Based on our experience, we suggest several measures for the prevention of orbital emphysema including the use of sharp osteotomes, 9 limited subperiosteal pre-tunneling, closure of piriform access, 11 nasal packing, 9 avoiding lateral massage, 9 sinus precautions, and deliberate surgical technique.…”

Case Report: Atraumatic Orbital Emphysema after Bronchoscopy with Endobronchial Biopsy

“…The accumulation of air inside the eyelid or orbit is commonly caused by blunt orbital or facial trauma and may occur, although not often, from atraumatic events such as sneezing or coughing, 1 or as a complication after surgery. [2][3][4] Although it is important to rule out orbital or facial trauma when orbital emphysema is observed, other differential diagnoses include infection with gas-producing organisms and orbital foreign body. Orbital emphysema is associated with sudden-onset unilateral painless periorbital swelling with crepitus upon palpation.…”