Disseminated head and neck emphysema with pneumocephalus due to air compressor injury into orbit

Abstract

Since the first report at 1970, air compressor injuries with orbital facial emphysema have been reported in approximately 11 English literatures [1]. Among these, 3 cases were pneumocephalus-associated severe injuries [2], [3], [4]. In the English literature, this is one of the most severe cases with head and neck emphysema after air compressor injury, which I reported to the government's labor department as a rare serious injury.

While playing at an auto repair shop, a healthy 4-year-old girl was struck with a compressed air gun by her brother in the right eye, as a result of which, the said eye was directly hit, at a close range, by a high-pressure air stream (75 psi). She complained of severe pain and swelling of both eyelids. She presented to the emergency department immediately.

Crying and irritability created visual acuity test was unavailable. With the girl sedated, pupil examination revealed both round pupils (size, 0.3/0.3) without relative afferent pupillary defect. There was no commotio retinae on dilated fundoscopy. Extensive edema and ecchymosis in both eyelids were present, which were more severe in the right. The right palpebral fissure opened only 3 mm with voluntary effort. The most striking finding was a massive swelling of the conjunctiva in the right eye throughout 360°, apparently caused by air, with a 5- to 6-mm-sized jagged conjunctival laceration at the 12 o'clock position. The sclera was completely intact. The corneas were clear, and the anterior chamber quiet. Crepitus was present over the upper and lower eyelids of both eyes and extended into the nose, cheek, scalp, lower jaw, and temporomandibular joint on both sides. The ocular movements were normal.

Plain skull x-ray showed massive emphysematous change on the face, ranging from the parietotemporal area to the submandibular area on both sides (Fig. 1). Computed tomography scans (Fig. 2) showed extensive emphysema over both the periorbital area and in the right orbit with pneumocephalus. No fracture was noted in any section.