Facial and Periorbital Emphysemas Following a Violent Sneezing: An Atypical Clinical Situation

Abstract

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.