An unusual presentation of orbital floor fracture

Pneumomediastinum as a Complication of Oral and Maxillofacial Injuries: Report of 3 Cases and a 50-Year Systematic Review of Case Reports

Objectives

Pneumomediastinum (PM) secondary to oromaxillofacial trauma (OMF) is a rare but well-described complication/pathologic finding. The aim of this study was twofold: first, to report our experience in treatment of maxillofacial trauma patients with PM, and second, to review the literature regarding the clinical features, severity, course, and management of the aforementioned complication.

Material and methods

We retrospectively reviewed the medical records and charts of patients who suffered from maxillofacial trauma and treated in our hospital between September 1, 2013 and September 31, 2017. The inclusion criteria were patients with radiologically confirmed PM. In addition, the electronic databases PubMed, Scopus, and Science Direct were queried for articles reporting PM cases secondary to OMF injuries and published in English, French, and German language.

Results

Three cases of PM out of 3,514 cases of craniomaxillofacial trauma were found; there were 3 male patients who presented in our emergency department with the chief complaint of cervicofacial swelling. Literature search isolated 58 selected articles and 63 cases were assessed in total; posttraumatic repeated blowing of nose was proved as most frequent triggering factor among them. Furthermore, the outcomes of review showed that thoracic pain, respiratory distress, and swallowing difficulties were not frequently reported in patients with ME due to facial trauma.

Conclusions

Both our experience and the results of systematic literature review indicated that patients with PM due to OMF injuries present mild clinical course. If properly managed, this specific pathologic condition may have no further complications or relative comorbidities. The exact etiology and mechanism of PM in the context of maxillofacial injuries always needs to be identified. Radiographic, laboratory, and endoscopic examinations should be applied to rule out the more serious and frequently diagnosed aerodigestive, thoracic, and abdominal causes of PM.

Post-traumatic temporal bone pneumatocele presenting after aggressive Valsalva

We report a case of a temporal bone pneumatocele with full-thickness erosion of the cranium associated with aggressive nose blowing. This condition presented 9 years after traumatic fracture of the temporal bone. There are 17 reported cases of mastoid sinus hyperpneumatisation in the literature. Eleven of the 17 are associated with Valsalva manoeuvres or elevated middle ear pressure. However, no other cases of full-thickness erosion at the site of a former fracture have been reported. We propose that the fracture, in combination with elevated mastoid sinus pressure from aggressive nose blowing, led to escape and trapping of pressurised air in the epidural and subcutaneous spaces, which resulted in bone erosion.

Retropharyngeal and cervicofacial subcutaneous emphysema after maxillofacial trauma

INTRODUCTION

Subcutaneous emphysema in the cervical region is a well-documented event that may occur secondary to tonsillectomy, dental treatment, oropharyngeal barotraumas, scaling and root planning therapy, punch biopsy, endotracheal intubation, orthognathic surgery, extraction of impacted teeth, or after maxillofacial trauma. After trauma episodes, subcutaneous emphysema may be caused by a maxillary antral wall fracture that occurs when air pressure is introduced into the fascial planes of the connective tissue. Retropharyngeal emphysema is a severe condition associated with traumatic aerodigestive tract injury and may be associated with life-threatening situations requiring prompt attention and diagnosis in order to prevent serious consequences.

CASE REPORT

We reported a case of cervicofacial and retropharyngeal emphysema in a 54-year-old patient who stated concerns after blowing his nose several times after a traumatic episode involving orbitozygomatic region. During the patient's hospital course, his airway remained stable, and he was discharged from the hospital 7 days later with a prognosis of full recovery, excellent occlusion and facial appearance, and complete resolution of subcutaneous emphysema.

Delayed traumatic ocular emphysema: a case report

A 47-year-old man sustained fractures of the left orbita and zygomatic bone after a fall. He was advised to visit an oral and maxillofacial department for more detailed evaluation and treatment, but ignored the advice. Four days later, after sneezing and blowing his nose, he presented severe exophthalmos, diplopia, and reduction of vision. Two days after the symptoms presented he asked for oral and maxillofacial surgery consultation. He refused any surgical intervention and was treated conservatively. The recovery was slow and 1 week later he was discharged with slight esthetic problems.

Traumatic subcutaneous emphysema of the face associated with paranasal sinus fractures: a prospective study

PURPOSE

The purpose of this report was to review and analyze the epidemiologic features of traumatic subcutaneous emphysema (TSE) originating from frontal, nasoethmoidal, and maxillary facial injuries with sinusal involvement in the emergency room setting.

PATIENTS AND METHODS

All patients with a fracture involving the paranasal sinuses were evaluated with regard to TSE occurrence. Data analysis extended to gender, age, etiology, fracture sites, TSE location, sinus involvement, treatment, and complications from April 1999 to December 2003. Evaluation methods included computed tomography scan and clinical evaluation.

RESULTS

A total of 390 patients sustaining 458 paranasal sinus fractures were included. TSE was observed in 29 patients (7.43%) patients (male-female ratio of 3.83:1, with a mean age of 36.71 +/- 15.71 years). The main etiologies were vehicle accidents and assaults. Isolated maxillary sinuses fractures were found in 17 cases (58.62%). Ethmoidal and maxillary fractures were associated with 9 cases (31.03%), and 1 (3.45%) case had maxillary and frontal fractures together. Ethmoidal, maxillary, and frontal fractures were found concomitantly in 2 (6.90%) cases. Periorbital emphysema was the most prevalent site of presentation, and edema (86.21%) and bone deformities (79.31%) were the most frequent findings associated with TSE. Conservative treatment was the prevalent treatment choice (55.17%), and 1 complication because of persistent pain was noted.

CONCLUSION

The results suggest that TSE of the face associated with paranasal sinus fractures maintained the clinical features of its fractures of origin. The ethmoidal sinuses were considered as the most prevalent etiologic site, and the periorbital region was responsible for addressing the higher incidence of SE following paranasal sinus fractures.

Orbital emphysema and the medial orbital wall: a review of the literature with particular reference to that associated with indirect trauma and possible blindness

Orbital emphysema is not an uncommon finding following fractures of the facial skeleton. Both its significance as a threat to sight and its diagnostic value may well be underestimated. Fractures of the paranasal sinuses may occur as a result of indirect trauma. This article reviews the literature on the subject with particular reference to blindness as a possible sequel. Two cases of orbital wall fracture that occurred as a result of indirect trauma and which produced orbital emphysema are discussed.

The management of zygomatic complex fractures--results of a survey

A study was undertaken to investigate the current practices in the UK in the management of zygomatic complex fractures. The results are presented and discussed with reference to recent literature on the subject.