Periorbital Subcutaneous Emphysema in Rhinoplasty

Charles-de-Sá, Luiz; Faria, Diogo Melgaço; Benedetti, B.; Castro, Cláudio Cardoso de; Aboudib, José Horácio

doi:10.1177/1090820x14526616

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

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Acute Diplopia Following Rhinoplasty: Clearing the Air

et al. 2021

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Diplopia after rhinoplasty is a rare complication that requires immediate medical attention. Workup should include a complete history and physical examination, appropriate imaging, and consultation with ophthalmology. Diagnosis may be challenging due to the wide differential ranging from dry eyes to orbital emphysema to an acute stroke. Patient evaluation should be expedient, though thorough to facilitate time-sensitive therapeutic interventions. Here, we present a case of transient binocular diplopia presenting 2 days after closed septorhinoplasty. The visual symptoms were attributed to either intra-orbital emphysema or a decompensated exophoria. This is the second documented case of orbital emphysema after rhinoplasty presenting with diplopia. It is the only case with a delayed presentation as well as the only case that resolved after positional maneuvers.

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Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

Acute Diplopia Following Rhinoplasty: Clearing the Air

et al. 2021

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“…Blindness following rhinoplasty is mostly caused by occlusion of the central retinal artery. Also, its embolization as a result of intranasal injection of local anesthetics has to be considered [ 29 , 28 ]. Furthermore, there are numerous well-established risk factors associated with the occurrence of ophthalmic complications after rhinoplasty, such as injection of local anesthetic into the artery while doing mucosa injection during surgery can lead to occlusion of the vessels of the optic nerve.…”

Section: Reviewmentioning

confidence: 99%

“…It is also hypothesized that air leakage to the orbital region can lead to visual loss via compressive optic neuropathy. Although the incidence of such an event is rare, a case report was published (summarized in Table 3 ) of a 35-year-old woman with no significant medical history who developed subcutaneous periorbital emphysema after undergoing closed-structured rhinoplasty immediately after extubation, which was interfered with by the patient’s agitation and Valsalva maneuvers [ 29 ]. This was followed by bilateral periorbital swelling without crepitation.…”

Section: Reviewmentioning

confidence: 99%

Ophthalmic Complications of Periorbital and Facial Aesthetic Procedures: A Literature Review

Alharbi,

Bin Dlaim,

Alqahtani

et al. 2023

Cureus

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The emergence and popularity of cosmetic facial procedures may lead to significant ophthalmic complications such as ocular motility dysfunction and visual disability. Here, we present a scoping review to identify common ophthalmic complications in some facial plastic surgeries and cosmetic injections, and to develop clinical approaches for prophylaxis and management in terms of direct attention and awareness of non-ophthalmologists toward such scenarios and appropriate intervention. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following keywords were used to search PubMed, Scopus, Web of Science, and Google Scholar: “facial laser”, “facial fillers”, “facial injections”, “hyaluronic acid”, “local facial injections of botulinum toxin”, “rhinoplasty”, “blepharoplasty blindness”, “ophthalmoplegia”, “diplopia”, “ptosis”, “ophthalmic artery occlusion”, “posterior ciliary artery occlusion”, and “ocular ischemic syndrome”. A total of 37 articles published between 1989 and 2021 were included, of which 21 were case reports. The most common ophthalmic complication was vision loss (0.0008%). The risk of ophthalmic complications including ocular pain, sudden unilateral or bilateral vision loss, flashes of light, ptosis, and ophthalmoplegia increase with injection in common anatomical regions like the glabella, nose, and supraorbital and nasolabial folds. The incidence of adverse events ranges from 5% to 18% in rhinoplasty. The most common complications after blepharoplasty were dry eye syndrome and diplopia, caused by eyelid ptosis. Eyelid, cornea, lens, and retina injuries are ophthalmic complications that occur after facial laser treatment. Ophthalmic complications after non-ophthalmic and cosmetic procedures are becoming increasingly common. The cumulative reported cases of ophthalmic complications after hyaluronic acid filler injection from 2016 to 2020 showed different types of adverse events, with the most common being decreased visual acuity, unilateral vision loss, and ptosis, with varying outcomes of each complication ranging from partial resolution to complete recovery. These complications must be recognized early, and prompt treatment must be established.

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“…It has been reported after maxillofacial surgeries, dental interventions, endoscopic sinus surgeries, and procedures such as rhinoplasty. 1,2,3,4 Although periorbital emphysema is rare, it can lead to conditions that require urgent decompression. In this case report, a patient with periorbital emphysema was evaluated.…”

Section: Introductionmentioning

confidence: 99%

Periorbital Emphysema After Endoscopic Nasal Polyp Surgery

Çınar¹,

Yüce

Fece³

et al. 2019

tjo

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Periorbital and subcutaneous emphysema after transnasal endoscopic surgery are rare. Periorbital emphysema has been reported after facial trauma, dental interventions, procedures such as endoscopic sinus surgery and rhinoplasty, and due to medications such as systemic steroids. Although very rare, it may require urgent intervention because of the risk of increased intraocular pressure and impaired blood supply to the globe. The otolaryngology department requested ophthalmology consultation for a 65-year-old male patient who had severe periorbital emphysema of the right eye the day after endoscopic nasal polypectomy due to severe coughing and straining. Crepitus was detected on skin palpation and immediate intervention was performed by passing a 21-gauge needle through the skin into the subcutaneous tissue of the upper and lower eyelids to evacuate the subcutaneous air. The patient’s clinical symptoms resolved with no postoperative complications.

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Periorbital Subcutaneous Emphysema in Rhinoplasty

Cited by 8 publications

References 14 publications

Acute Diplopia Following Rhinoplasty: Clearing the Air

Acute Diplopia Following Rhinoplasty: Clearing the Air

Ophthalmic Complications of Periorbital and Facial Aesthetic Procedures: A Literature Review

Periorbital Emphysema After Endoscopic Nasal Polyp Surgery

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