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A peculiar blow-out fracture of the inferior orbital wall complicated by extensive subcutaneous emphysema: A case report and review of the literature.

Rzymska-Grala I, Palczewski P, Błaż M, Zmorzyński M, Gołębiowski M, Wanyura H - Pol J Radiol (2012)

Bottom Line: However, not many cases are associated with massive subcutaneous emphysema.Even fewer cases are caused by minor trauma or are associated with barotrauma to the orbit due to sneezing, coughing, or vomiting.The patient did not remember any significant trauma to the head that could explain the above mentioned findings.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland.

ABSTRACT

Background: Blow-out fracture of the orbit is a common injury. However, not many cases are associated with massive subcutaneous emphysema. Even fewer cases are caused by minor trauma or are associated with barotrauma to the orbit due to sneezing, coughing, or vomiting. The authors present a case of blow-out fracture complicated by extensive subcutaneous and mediastinal emphysema that occurred without any obvious traumatic event.

Case report: A 43-year-old man presented to the Emergency Department with a painful right-sided exophthalmos that he had noticed in the morning immediately after waking up. The patient also complained of diplopia. Physical examination revealed exophthalmos and crepitations suggestive of subcutaneous emphysema. The eye movements, especially upward gaze, were impaired. CT showed blow-out fracture of the inferior orbital wall with a herniation of the orbital soft tissues into the maxillary sinus. There was an extensive subcutaneous emphysema in the head and neck going down to the mediastinum. The patient did not remember any significant trauma to the head that could explain the above mentioned findings. At surgery, an inferior orbital wall fracture with a bony defect of 3×2 centimeter was found and repaired.

Conclusions: Blow-out fractures of the orbit are usually a result of a direct trauma caused by an object with a diameter exceeding the bony margins of the orbit. In 50% of cases, they are complicated by orbital emphysema and in 4% of cases by herniation of orbital soft tissues into paranasal sinuses. The occurrence of orbital emphysema without trauma is unusual. In some cases it seems to be related to barotrauma due to a rapid increase in pressure in the upper airways during sneezing, coughing, or vomiting, which very rarely leads to orbital wall fracture. Computed tomography is the most accurate method in detecting and assessing the extent of orbital wall fractures.

No MeSH data available.


Related in: MedlinePlus

Axial image and multiplanar reformations in lung window show a large intraorbital emphysema (A,B) extending into the spaces of the neck (C,D) and the superior mediastinum (arrows in E).
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f2-poljradiol-77-2-64: Axial image and multiplanar reformations in lung window show a large intraorbital emphysema (A,B) extending into the spaces of the neck (C,D) and the superior mediastinum (arrows in E).

Mentions: Physical examination revealed severe right-sided exophthalmos with upgaze restriction of the right eye, accompanied by diplopia. Additionally, extensive subcutaneous emphysema was palpable in the right palpebrae, cheek and submandibular area on that side. A spiral CT of the facial skeleton was performed using 1-mm slices with soft tissue and bone algorithm. A large intraorbital emphysema with exophthalmos was found (the distance from corneal apex to the line connecting orbital rims was 29 mm (normal range up to 21 mm)) (Figure 1). Air was entering soft tissues of temporal and subtemporal fossa, buccal space, masticator space, parotid gland, para- and retropharyngeal space, carotid space and along the visceral space of the neck to the anterior and posterior mediastinum (Figure 2). Multiplanar reconstructions in the “bone” window showed a right-sided blow-out fracture of the lower orbital wall with slight herniation of intraorbital adipose tissue into the maxillary sinus (Figure 3).


A peculiar blow-out fracture of the inferior orbital wall complicated by extensive subcutaneous emphysema: A case report and review of the literature.

Rzymska-Grala I, Palczewski P, Błaż M, Zmorzyński M, Gołębiowski M, Wanyura H - Pol J Radiol (2012)

Axial image and multiplanar reformations in lung window show a large intraorbital emphysema (A,B) extending into the spaces of the neck (C,D) and the superior mediastinum (arrows in E).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3403804&req=5

f2-poljradiol-77-2-64: Axial image and multiplanar reformations in lung window show a large intraorbital emphysema (A,B) extending into the spaces of the neck (C,D) and the superior mediastinum (arrows in E).
Mentions: Physical examination revealed severe right-sided exophthalmos with upgaze restriction of the right eye, accompanied by diplopia. Additionally, extensive subcutaneous emphysema was palpable in the right palpebrae, cheek and submandibular area on that side. A spiral CT of the facial skeleton was performed using 1-mm slices with soft tissue and bone algorithm. A large intraorbital emphysema with exophthalmos was found (the distance from corneal apex to the line connecting orbital rims was 29 mm (normal range up to 21 mm)) (Figure 1). Air was entering soft tissues of temporal and subtemporal fossa, buccal space, masticator space, parotid gland, para- and retropharyngeal space, carotid space and along the visceral space of the neck to the anterior and posterior mediastinum (Figure 2). Multiplanar reconstructions in the “bone” window showed a right-sided blow-out fracture of the lower orbital wall with slight herniation of intraorbital adipose tissue into the maxillary sinus (Figure 3).

Bottom Line: However, not many cases are associated with massive subcutaneous emphysema.Even fewer cases are caused by minor trauma or are associated with barotrauma to the orbit due to sneezing, coughing, or vomiting.The patient did not remember any significant trauma to the head that could explain the above mentioned findings.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland.

ABSTRACT

Background: Blow-out fracture of the orbit is a common injury. However, not many cases are associated with massive subcutaneous emphysema. Even fewer cases are caused by minor trauma or are associated with barotrauma to the orbit due to sneezing, coughing, or vomiting. The authors present a case of blow-out fracture complicated by extensive subcutaneous and mediastinal emphysema that occurred without any obvious traumatic event.

Case report: A 43-year-old man presented to the Emergency Department with a painful right-sided exophthalmos that he had noticed in the morning immediately after waking up. The patient also complained of diplopia. Physical examination revealed exophthalmos and crepitations suggestive of subcutaneous emphysema. The eye movements, especially upward gaze, were impaired. CT showed blow-out fracture of the inferior orbital wall with a herniation of the orbital soft tissues into the maxillary sinus. There was an extensive subcutaneous emphysema in the head and neck going down to the mediastinum. The patient did not remember any significant trauma to the head that could explain the above mentioned findings. At surgery, an inferior orbital wall fracture with a bony defect of 3×2 centimeter was found and repaired.

Conclusions: Blow-out fractures of the orbit are usually a result of a direct trauma caused by an object with a diameter exceeding the bony margins of the orbit. In 50% of cases, they are complicated by orbital emphysema and in 4% of cases by herniation of orbital soft tissues into paranasal sinuses. The occurrence of orbital emphysema without trauma is unusual. In some cases it seems to be related to barotrauma due to a rapid increase in pressure in the upper airways during sneezing, coughing, or vomiting, which very rarely leads to orbital wall fracture. Computed tomography is the most accurate method in detecting and assessing the extent of orbital wall fractures.

No MeSH data available.


Related in: MedlinePlus