Periorbital Emphysema Research Articles

Periorbital emphysema following dental procedure: A case report with literature review

We aimed to present a case of periorbital emphysema after tooth extraction in private dental practice. A 20-year-old female patient with the left maxillary first molar tooth extracted under local anesthesia was referred to the ophthalmologist with complaints of swelling and pain around the left eye 6 hours after the procedure. The best visual acuity was logMAR 0.0 in both eyes on visual examination. In the slit-lamp examination, there was periorbital swelling in the left eye, free eye movement, and a light reaction. The right eye followed naturally. Fundus examination of the bilateral optic nerve was normal. On palpation, crepitation was detected in the left periorbital region. A rapid assessment of airway obstruction was made. Diffuse air was observed in the left orbital soft tissue in orbita computed tomography. Prophylactic penicillin-derived antibiotics and nonsteroidal antibiotics were started. The light reaction was followed closely. Periorbital swelling decreased 24 hours after the procedure. During the surgical removal of impacted teeth, air through the air-operated handpiece may cause spread from the periapical region to the periorbital space along the subperiosteal region and fascial planes. Care should be taken to avoid this rare complication after dental procedures.

First report of post-vomiting subcutaneous peri-lacrimal drainage system emphysema

Subcutaneous emphysema is defined as a trapped air in tissues under the skin. This entity most often occurs in the chest wall and neck but can infrequently happen in other parts of the body like the orbital area [1]. The main mechanism of subcutaneous emphysema is the traumatic damage of the anatomical air-filled cavities or canals. Most of the rare, reported cases of orbital and periorbital emphysema were described in adults as complications of several types of traumas, including direct trauma, recent or previous surgery [2,3], barotrauma secondary to non-invasive ventilation, such as continuous positive airway pressure therapy [4], and even post forceful nose-blowing [5]. In this report, we described the first reported case of post-vomiting subcutaneous emphysema surrounding the medial canthus of the right eye in a 10-year-old boy.

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

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.

Подкожная эмфизема век как возможное осложнение эндоназальной эндоскопической дакриоцисториностомии

Periorbital subcutaneous emphysema, most often seen after trauma or stomatology procedures, is an unexpected and extremely rare condition after endonasal endoscopic dacryocystorhinostomy (EEDCR). It may be misdiagnosed as angioneurotic edema or eyelid phlegmon. The authors studied 2 011 cases of uncomplicated EEDCR and found 22 cases of periorbital edema with crepitation in the early post-op period. The analysis did not discover a significant dependence of complications on the technique of operations. In all cases subcutaneous emphysema has developed on the second-third day after successful EEDCR. Patients questioning showed that the reason of complication was sneezing or forced nose blowing. Subcutaneous eyelid emphysema after EEDCR is a rare complication and makes, according to our data, only 1 % of all operations. In most cases it regresses spontaneously but requires control of patients' visual functions. Patients should be recommended to avoid actions which can cause strong changes of pressure, such as strong cough, sneezing, and effort. Key words: endonasal dacryocystorhinostomy, emphysema, complication.

EXPERIENCE OF DOING ENDOSCOPIC SINUS SURGERY FOR CHRONIC MAXILLARY SINUSITIS WITHOUT PRE-OPERATIVE CT-SCAN IN A PERIPHERAL HOSPITAL

Objective: To determine frequency of our complications of endoscopic sinus surgery without pre-operative CT-Scan and to compare this frequency with other similar studies done with the help of pre-operative CT-Scans.
 Study Design: Cross sectional study.
 Place and Duration of Study: ENT Department, Combined Military Hospital Skardu Pakistan, from Jun 2017 to Jun 2019.
 Methodology: Total 69 patients (116 Sides) were operated under general anesthesia by using 0 and 30 degree endoscopes to address the Maxillary sinusitis. Frequency of complications was compared to other studies by applying chi-square test for goodness of fit. The complications were also correlated to ages of patients by applying Spearman correlation analysis.
 Results: Mean age was 29.75 ± 10.9 years (range 15-75). Overall complications rate was 4.3% (5 out of 116 sides, 95% confidence interval 4.23-4.4). Peri-orbital ecchymosis and peri-orbital emphysema were most commonly occurring complications (4.3%). This complication rate was compared to few other studies, which proved that difference was not statistically significant. Correlation of occurrences of orbital complications with the age proved that there was no statistically significant correlation (Correlation coefficient r=-0.085, p-value 0.276).
 Conclusion: Isolated chronic maxillary sinusitis refractory to medical treatment can be treated by endoscopic sinus surgery without pre-operative CT-Scan.

Fibrous Dysplasia of the Frontal Sinus Presenting with Periorbital Emphysema

Fibrous dysplasia (FD) is an uncommon non-malignant bony tumor in which normal bone is replaced by disorganized fibro-osseous tissue. It most often involves the femur, ribs, and craniofacial skeleton and is commonly diagnosed in adolescence or early adulthood. Involvement of the paranasal sinuses is rare, and there is a relative paucity of case reports in the literature. Here, we report a case of FD of the frontal sinus in a 22-year-old male initially presenting with acute onset periorbital emphysema after nose-blowing. Radiographic examination revealed an expansile lesion with “ground-glass” appearance. The patient underwent resection and reconstruction by combined endoscopic and external approach with osteoplastic flap by a multidisciplinary team. The diagnosis of FD was confirmed by permanent histopathology. This report reviews the presentation and treatment of FD of the paranasal sinuses and details a combined external and endoscopic approach to resection of the frontal sinus mass.

Endoscopic treatment of ectopic teeth in the maxillary sinus.

BackgroundEctopic teeth in maxillary sinus is rare and are usually removed via sub-labial trans-canine fossa approach (SLCFA). The aim of our study was to present our experience with extraction of ectopic teeth in the maxillary sinus via transnasal endoscopic approach (TEA). Material and Methods Rhinologists were asked to share their experience in the management of ectopic teeth in the maxillary sinus. Data were reviewed retrospectively. Results Eleven cases were reported in 10 patients from 2010 to 2019, six males and four females with a mean age of 33.5 +/-17 years (range 16 to 61). Seven patients complained of sinonasal symptoms, two were diagnosed incidentally during routine dental work-up, and one had oro-antral fistula. In eight patients, a cyst coexisted within the maxillary sinus. Teeth were located arbitrarily within the sinus. All cases were operated by TEA. One patient had self-limited periorbital emphysema, one had transient cheek numbness, and one had early post-operative bleeding that stopped after endoscopic cauterization. Long-term follow-up revealed good clinical outcomes. ConclusionsTransnasal endoscopic removal of ectopic teeth from the maxillary sinus is a feasible and rational approach when SLCFA is contraindicated. Key words:Ectopic teeth, dentigerous cyst, endoscopic sinus surgery, Caldwell-Luc.

Air in the Eyelids! Pneumomediastinum and Periorbital Emphysema in a Patient of Dermatomyositis.

Article Air in the eyelids! Pneumomediastinum and periorbital emphysema in a patient of dermatomyositis was published on December 1, 2020 in the journal Rheumatology and Immunology Research (volume 1, issue 1).

Periorbital emphysema after accidental root canal perforation: Case report

Introduction: Subcutaneous emphysema is a rare dental complication of severe medical complication.Proper case diagnosis and management rely only upon a published case report. The dentist could easily misdiagnosis such cases. In this case report, we presented precise case management from diagnosis to prevention.Objective: provided clear guidelines regarding diagnosis, management and prevention.Methodology: We presented a report of an interesting clinical case of periorbital emphysema develops immediately after using airway syringe to dry root canal.

Peri-orbital surgical emphysema following endoscopic dacryocystorhinostomy.

Peri-orbital surgical emphysema is a rare complication that can occur after lacrimal surgery. It has only been described in isolated cases, following external dacryocystorhinostomy (n = 2) and Lester Jones tube insertion (n = 1). A retrospective, non-comparative case series was conducted of patients who developed surgical emphysema following endoscopic dacryocystorhinostomy. A total of 356 endoscopic dacryocystorhinostomy cases (primary, n = 316; revision, n = 40) were performed over a six-year period. Seven cases of post-operative surgical emphysema were identified, all of which were preceded by uncontrolled sneezing, nose-blowing or coughing within the first week of surgery. The occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy in our centre was 7 in 356, or 2 per cent, over six years. This is the first study to report the occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy. Clinicians may wish to suggest patients stifle the aforementioned triggers within the first week to reduce the potential for surgical emphysema.

Non-traumatic Orbital Emphysema following suspected COVID-19 infection

Orbital emphysema is a well-known entity in which there is communication between the orbit and sinuses. Trauma is the leading cause. Spontaneous fractures of orbital wall are rarely reported. Ours is a unique case of spontaneous orbital emphysema with fracture of multiple walls of orbit in a patient following COVID-19 infection. Examination revealed soft tissue swelling, proptosis and prominent chemosis. CT scan report noted marked asymmetrical left sided proptosis, preseptal and periorbital emphysema secondary to fracture of medial wall and roof of orbit. We managed the patient conservatively by oral antibiotics and close monitoring of optic nerve functions.

Dehiscence of the lamina papyracea

We report the case of a 35 year old patient presenting with acute onset of right periocular pain with palpebral edema due to nose blowing with absence of trauma. Early assessment showed periorbital emphysema without ophthalmological involvement, normal pupillary light reflex and visual acuity. Computerized tomography (CT) scan of facial and orbital bones objectified right pneumo-orbita with orbital fat herniation via a partial agenesis of the lamina papyracea, without muscle incarceration. Emphysema gradually reduced after two weeks by applying pressure dressing associated with broad spectrum antibiotic therapy as well as following the rules for cleanliness (avoiding closed glottis efforts, nose blowing…). Pneumo-orbita is defined by the presence of orbital air. It is mainly caused by a trauma but few cases of spontaneous dehiscence have been reported. The opening of the lamina papyracea, acting as an antireflux valve, prevents air outlet. CT scan is essential to confirm the diagnosis. It most often has a spontaneous resolution but the presence of hyperpression, that can be responsible for ischemic optic neuropathy or occlusion of the central artery of the retina, require a rigorous monitoring in order to implement possible urgent decompressive intervention.

Periorbital emphysema following dental procedure: A case report and literature review

Periorbital emphysema following dental procedure: A case report and literature review

Can Clinical Findings Predict Orbital Fractures and Treatment Decisions in Patients With Orbital Trauma? Derivation of a Simple Clinical Model

The aim of this study was to determine the predictive value of 4 clinical signs (periorbital ecchymosis, periorbital emphysema, diplopia, and inferior orbital nerve hypoesthesia) for the diagnosis of orbital fractures (OFs) and the need for surgical treatment in patients with orbital trauma. The investigators designed and implemented a retrospective cohort study composed of patients with orbital trauma. The primary and secondary outcomes were respectively the diagnosis of OFs and the need for surgical treatment. Multivariable logistic regressions including the clinical signs, age, and causes of injury were used to determine the independent contribution of each clinical sign to the prediction of the outcomes and to obtain weights to compute OF and surgery scores. The outcomes were assessed by receiver-operating characteristic (ROC) curves, sensitivity, specificity, and positive and negative predictive values. A total of 912 patients were included. All clinical signs except periorbital ecchymosis were significantly associated with OFs and the need for surgical treatment (P < 0.001). The predictive power of each clinical sign taken separately was moderate for the 2 outcomes (area under ROC curve [AUC] <0.7). A better predictive value was found when all clinical signs were used together (AUC >0.7). Patients with an OF score >3 were likely to have an OF and patients with a surgery score ≤2 were unlikely to have surgery.The present study demonstrated that our OF and surgery scores resulted in an effective model that allowed the stratification of patients with orbital trauma based on their risk of having OFs and risk of needing a surgical treatment.

Perforated Colonic Diverticula Presenting as Periorbital and Cervical Subcutaneous Emphysema

Perforated Colonic Diverticula Presenting as Periorbital and Cervical Subcutaneous Emphysema

Periorbital and mediastinal emphysema after upper gastrointestinal endoscopy: Case report of a rare complication

Purpose:To report a rare case of periorbital emphysema concurrent with cervicofacial and mediastinal emphysema in an elderly woman who underwent upper gastrointestinal endoscopy for chronic liver disease.Case Report:An elderly woman with decompensated chronic liver disease presented with features of periorbital, facial, and mediastinal emphysema, characterized with crepitant swelling over the right periorbital area, face, neck, and mediastinum after undergoing upper gastrointestinal endoscopy. There was no history of trauma or Valsalva maneuver. Ocular findings were stable with no evidence of orbital compartmental syndrome. Urgent computed tomography scans of the orbit and chest were performed, and emergency systemic treatment with nasogastric decompression and antibiotics was initiated. However, she suddenly collapsed and succumbed despite all resuscitative efforts.Conclusion:Our case demonstrates that periorbital emphysema can occur following procedures such as upper gastrointestinal endoscopy, in the eyes without history of local trauma. This complication should be suspected especially if there is associated cervicofacial and mediastinal emphysema. Subcutaneous emphysema is usually self-resolving; however, extension of air into deeper planes can cause dangerous complications such as blindness due to orbital emphysema or mortality due to mediastinal emphysema. Hence, prompt diagnosis and urgent intervention are crucial to avoid vision and life threatening complications.

Periorbital Subcutaneous Emphysema

Forty years old male was admitted with fever, cough and breathlessness since five days. Examination revealed signs of pleural effusion on left side of chest. Chest X-Ray showed left sided pleural effusion and left middle zone consolidation. Pleural fluid analysis suggested empyema. Patient was managed with intravenous antibiotics and left-sided inter-costal tube drainage. A day after thoracostomy patient developed swelling around eyes and thoracostomy site. Diffuse crepts were palpable around eyes, left side of chest and neck (Figure 1). CT confirmed the diagnosis of subcutaneous emphysema around eyes and chest wall. Swelling disappeared with conservative management within next three days (Figure 2). Periorbital emphysema is mostly due to disruption in the integrity of orbital boundaries because of trauma and subsequent orbital and sinus fractures. Less frequently follows dental surgeries. As a result of continuity of facial planes it can rarely occur as a result of spread from neck and chest subcutaneous tissue.

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

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. Keywords: Orbital emphysema, complication, septorhinoplasty, osteotomy. Read more →

A Rare Complication of Rhinoplasty: Periorbital Emphysema

Subcutaneous emphysema is a clinical entity that may be associated with trauma. Rhinoplasty is not an atraumatic procedure. This report presents a case of acute periorbital emphysema after cosmetic rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Subcutaneous and Periorbital Emphysema Following Dental Procedure

Subcutaneous emphysema following a dental procedure is a relatively uncommon phenomenon that may produce a dramatic clinical presentation. The advent of high-powered dental equipment that uses directed and highly pressurized air has increased the risk of this complication, but few cases have been described in the ophthalmic literature. The authors present a case of subcutaneous periorbital emphysema in a young woman following a dental procedure. Aside from a temporary ptosis, there were no other ophthalmic complications. An attempt to decompress the air produced minimal relief. The condition resolved spontaneously within 1 week.