期刊名称：Journal of Education and Teaching in Emergency Medicine
印刷版ISSN：2474-1949
出版年度：2018
卷号：3
期号：4
页码：5-7
DOI：10.21980/J8F05H
出版社：University of California Press
摘要：History of present illness: The patient is a 56-year-old male who presents with facial swelling after falling 3-
4 feet from a ladder, landing on his face. He had with no immediate swelling, but reports significant facial
and eyelid swelling immediately after blowing his nose. He denies any significant swelling to his eyelids.
Denies changes in vision or significant eye pain.
Significant findings: Physical exam showed marked left palpebral subcutaneous crepitus, as well as bulbar
and palpebral conjunctival bulging. Visual acuity was normal with intact extraocular movements, and normal
pupillary exam. Computed tomography (CT) imaging of the face was obtained and revealed multiple
displaced fractures involving the left orbital floor and zygomatic arch associated with moderate periorbital
and postseptal extraconal gas, resulting in orbital proptosis.
Discussion: Zygomatic arch and orbital floor are amongst the most common facial fractures.1 Facial traumatic
subcutaneous emphysema (TSE) is a well-documented complication,2-4 asis delayed occurrence of periorbital
emphysema due to coughing, sneezing, and blowing nose.5-7 TSE has been an identified sequela in about 7%
of all paranasal sinus fractures,4 and about 50% of all orbital wall fractures.
8 The majority of these cases
resolve spontaneously within 2 weeks and are typically managed non-operatively.4
Though complications are extremely rare, tension orbital emphysema leading to vision loss can occur. This is
commonly due to directly elevating the intraocular pressure or the sinus fracture causing a one-way valve
that increases periorbital pressure, with subsequently optic nerve or optic artery compromise.9-13 In these
cases, prompt needle decompression and high-dose oral steroid may be indicated.9-11 Because the
conjunctiva forms a continuous barrier, periorbital emphysema can manifest in global and palpebral
conjunctival emphysema. This may ultimately lead to exposure keratopathy and subsequent inability to close
the eyelids.
16,17
It is recommended that patients with sinus or periorbital fractures should refrain from coughing, blowing
nose, or forceful Valsalva and be prescribed antitussive medication and stool softeners.
