Introduction: Facial emphysema is the presence of air in the subcutaneous tissues of
the facial region. They can be clinically recognized by the crackling sensation
felt when the affected area is palpated. Observation: The authors describe left
orbito-facial emphysema that occurred after a violent sneezing episode in a
36-year-old patient. He had significant edema of the left facial and
ipsilateral periorbital region associated with major emphysema and complete
closure of the left eye. Nasal cavities endoscopy revealed inflammation of the
distal orifice of the nasolacrimal duct. The clinical ophthalmologic
examination performed in emergency showed left chemosis, slight ocular
hypertonia of mechanical origin, and a
slight decrease in visual acuity. Pupillary reflexes and retinography
were normal. A craniofacial computed tomography (CT) revealed a significant
left orbital emphysema, a fracture of the left medial orbital wall (ethmoidal
lamina papyracea) with intraconal fat incarceration without entrapment of the
medial rectus and significant air infiltration of all the left hemifacial soft
tissues. A broad-spectrum antibiotic and anti-inflammatory treatment were
instituted, as well as practical advice to prevent a recurrence. We observed
progressive resorption of the edema with a return to the normal of the soft
tissues and the palpebral cleft in 15 days.Conclusion: These atypical cases can be serious. It is essential to exclude signs of
visual deficit and ocular compression. Multidisciplinary management is
important.
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