Periorbital emphysema and pneumomediastinum following blunt orbital fracture: A case report and review of the literature

Abstract

Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such as pneumomediastinum (PM). PM is an uncommon complication of facial fractures and is defined as the presence of air in the mediastinal space. Developing PM following blunt trauma is commonly considered as a red flag for underlying injuries, such as trachea and esophagus rupture. Therefore, other complementary diagnostic procedures, including bronchoscopy and esophagostomy, are often necessary for patients developing this condition. Case Presentation: A 31-year-old man with a history of facial and neck trauma was presented to the emergency room of our tertiary referral hospital with a complaint of right orbital swelling. On physical examination, vital signs were stable. There was a mild swelling of right upper eyelid, but no proptosis. An hour after admission, following sneezing and blowing his nose, the patient had further swelling of his right face with extension of swelling through the right side of his neck to the nipple. He also complained of dyspnea and acute severe progressive epigastric pain. Conclusion: Orbital emphysema following orbital wall fracture is typically benign and selflimited, but physicians should be aware of serious complications such as PM. Therefore, monitoring the patient is crucial and should be considered in such conditions.

Periorbital Emphysema Due to Traumatic Pneumothorax

“…Periorbital emphysema (PE) is a rare clinical manifestation, and a bilateral presentation is even less frequent [1,2]. This condition is due to the forced entry of air into the orbital or periorbital tissues and its retention by a unidirectional valve mechanism since the mucosa seals the entry point with increased intraorbital pressure [1,3,4]. The most common cause is face trauma, with fractures of the maxillary sinus, particularly the zygomatic arch and orbital floor [1][2][3][4].…”

“…This condition is due to the forced entry of air into the orbital or periorbital tissues and its retention by a unidirectional valve mechanism since the mucosa seals the entry point with increased intraorbital pressure [1,3,4]. The most common cause is face trauma, with fractures of the maxillary sinus, particularly the zygomatic arch and orbital floor [1][2][3][4].…”

“…Crackling on palpation is the main clinical sign that differentiates this entity from others [2,4,5]. Normally, PE disappears spontaneously over a few days, as the air is reabsorbed [1,2,4]. However, it can progress and cause loss of vision, due to compartment syndrome of the orbit by compromising the optic nerve or retinal artery [1][2][3][4].…”