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We report a case of left traumatic orbital emphysema following motor-vehicle accident.
A 15 years old boy presented with multiple facial bone fracture after alleged history of fall with his face hitting the road while riding a motorcycle motor without a helmet. He had loss of consciousness with no ENT bleed. Upon arrival his vitals were all normal and triaged to the yellow zone. On examination, his GCS was 15. There was a swelling at glabella area with facial crepitus and tender on palpation, increased intercanthal distance, depressed nasal bridge and mobile nasal bone. Mild chemosis with subconjunctival emphysema of left eye was noted. CT brain showed multiple facial bone fracture involving nasal bone, nasal septum, ethmoid and sphenoid fracture, anterior and medial wall of both maxillary sinus with air entrapment at left lateral rectus muscle and lateral orbital wall. Nasal bone fracture was treated conservatively by ENT team. Ophthalmology team treated patient symptomatically with close monitoring. He was admitted to neurosurgery unit for pneumocranium with base of skull fracture. In ward, he developed cerebrospinal fluid (CSF) rhinorrhea and was started on intravenous antibiotics. No clinical deterioration or visual impairment was reported during the duration of admission in neurosurgery ward.
DISCUSSION & CONCLUSION
Be aware of risks in a patient with orbital emphysema. Sunconjunctival emphysema sign should be recognized by clinician so as not to miss the diagnosis. Although most are benign, some may develop orbital compartment syndrome (OCS) leading to irreversible optic nerve neuropathy requiring surgery. In a not too severe case, conservative management with regular assessment can be considered.
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