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Retrobulbar Orbital Emphysema Associated with Medial Orbital Wall Fracture

Dong, Quang Ngoc DDS, MSc*; Ide, Taichi DDS*,†; Karino, Masaaki DDS, PhD*,†; Okuma, Satoe DDS*,†; Koike, Takashi DDS*,†; Kanno, Takahiro DDS, PhD*,†

doi: 10.1097/SCS.0000000000005390
Clinical Study: PDF Only

Retrobulbar emphysema is a rare condition compared to the more common orbital emphysema. It is often associated with medial orbital wall fracture with rupture of the periosteum. In some severe patients, retrobulbar emphysema can increase the intraorbital pressure and lead to orbital compartment syndrome. Less extreme patients require only conservative treatment with careful observation. There is still no standard protocol for the management of orbital emphysema in general or specifically for retrobulbar emphysema. Visual acuity is the most widely used indicator to determine whether surgical intervention is needed. The patient presented here suffered from large retrobulbar intraconal emphysema and exophthalmos without visual loss after head trauma and nose blowing. He was observed closely without surgical intervention. After the emphysema had resolved, the patient's medial orbital wall defect was reconstructed using unsintered hydroxyapatite particles/poly L-lactide via the transcaruncular approach. The postoperative course has been uneventful with more than 1 year of follow-up to date.

*Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine

Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Japan.

Address correspondence and reprint requests to Takahiro Kanno, DDS, PhD, Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan; E-mail:

Received 13 December, 2018

Accepted 11 January, 2019

This work was in part supported by JSPS KAKENHI, Grant-in-Aid for Scientific Research (C) (#17K11803 to TK).

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.