Travmatik orbital amfizem olgularında klinik ve radyolojik özellikler

Year 2020, Volume: 4 Issue: 2, 122 - 125, 12.07.2020

Fatih Aslan , Çağlar Öktem

https://doi.org/10.30565/medalanya.659031

Abstract

Amaç: Çalışmamızda, orbita travmalarına bağlı görülen orbital amfizem (OA) olgularının klinik seyrini ve tedavi ihtiyaçlarını değerlendirmeyi amaçladık.

Gereç ve Yöntem: Bu retrospektif çalışmaya 2016-2019 yılları arasında hastanemiz acil servisine başvuran 82 hastanın 112 orbitası dahil edildi. Hastalarımızın ortak özelliği farklı nedenlerle ciddi yüz ve orbita travması yaşamış olmalarıydı. Glob veya orbita yaralanması ön tanısı ile göz hastalıklarına konsülte edilmiş bu hastaların orbita bilgisayarlı tomografileri (BT) OA yönünden değerlendirildi. Orbital havanın yerleşim yerine göre, preseptal, ekstrakonal, intrakonal ve intraoküler olarak sınıflandırıldı.

Bulgular: Çalışmaya dahil edilen 82 hastanın 65’i erkek, 17 tanesi ise kadındı. Hastaların genel yaş ortalaması 37,85 (3-78) idi. Cinsiyete göre bakıldığında erkek hastaların yaş ortalaması 36,09 (3-78), kadın hastaların yaş ortalaması ise 44,58 (15-78) olarak bulundu. 112 orbitanın 80 tanesinde preseptal sahada amfizem saptandı. Orbital havanın yerleşimi 80 gözde preseptal, 26 gözde ekstrakonal, 5 gözde intrakonal, 1 gözde ise intraokülerdi. Hiçbir hastamızda orbital kompartman sendromu tespit edilmedi.

Sonuç: Orbital amfizem orbita travmalarında sık karşılaşılan bir durumdur. Orbital kompartman sendromu ile ilişkili olabilir. Travma sonrası izlenen orbital amfizem genellikle iyi huylu kendini sınırlayan bir durumdur. 

Keywords

Orbital travma, orbita tomografisi, orbital amfizem

Clinical and radiological features of traumatic orbital emphysema cases

Abstract

Aim: In this study, we aimed to evaluate the clinical course and treatment requirements of orbital emphysema cases resulting from orbital trauma.

Material and Method: We included the 112 orbits of 82 patients who had presented to the emergency service of our hospital between 2016 and 2019 in this retrospective study. The common feature was severe orbital trauma due to various causes and referrals to the ophthalmology department with a preliminary diagnosis of ocular or orbital damage. The orbital computerized tomography images were evaluated for orbital emphysema and a classification was performed according to the location of the air as preseptal, extraconal, intraconal and intraocular. 

Results: We included a total of 82 subjects consisting of 65 males and 17 females in the study. The mean age was 37.85 (3-78) years in general, 36.09 (3-78) years in the males, and 44.58 (15-78) years in the females. Emphysema was present in the preseptal area in 80 cases, the extraconal area in 26, and the intraconal area in 5 of the 112 orbits. Intraocular emphysema was detected in only a single case. The orbital compartment syndrome was not present in any of our cases.

Conclusion: Orbital emphysema is a common condition in orbital trauma. It may be associated with the orbital compartment syndrome. Orbital emphysema after orbital trauma is usually a benign, self-limiting condition.

Keywords

Orbital trauma, orbital tomograph, orbital emphysema

References

• 1. Hunts JH, Patrinely JR, Holds JB, Anderson RL. Orbital emphysema. Staging and acute management. Ophthalmology. 1994;101:960-6. doi: 10.1016/S0161-6420(94)31230-9.
• 2. Van Issum C, Courvoisier DS, Scolozzi P. Posttraumatic orbital emphysema: incidence, topographic classification and possible pathophysiologic mechanisms. A retrospective study of 137 patients. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:737-42. doi: 10.1016/j.oooo.2012.10.021.
• 3. Moon H, Kim Y, Wi JM, Chi M. Morphological characteristics and clinical manifestations of orbital emphysema caused by isolated medial orbital wall fractures. Eye (Lond). 2016;30:582-7. doi: 10.1038/eye.2015.285.
• 4. Ozdemir O. Orbital emphysema occurring during weight lifting. Semin Ophthalmol. 2015;30:426-8. doi: 10.3109/08820538.2013.874469.
• 5. Mathew S, Vasu U, Francis F, Nazareth C. Transconjunctival orbital emphysema caused by compressed air injury: a case report. Indian J Ophthalmol. 2008;56:247-9. doi: 10.4103/0301-4738.40371.
• 6. Helvacı S, Öksüz H, Sahinoglu-Keskek N, Cevher S. Spontaneous Orbital Emphysema After Nose Blowing: Case Report. Turkiye Klinikleri J Ophthalmol. 2014;23:184-7.
• 7. Altınkurt E, Balcı Ö. A Case with Transconjunctival Orbital Emphysema Due to Air Compressor Injury. Turkiye Klinikleri J Ophthalmol. 2016;25:124-7. doi: 10.5336/ophthal.2014-43249.
• 8. Shah N. Spontaneous subcutaneous orbital emphysema following forceful nose blowing: treatment options. Indian J Ophthalmol. 2007;55:395. doi: 10.4103/0301-4738.33834.
• 9. Rodríguez-Cabrera L, Rodríguez-Loaiza JL, Tovilla-Canales JL, Zuazo F. Orbital emphysema as a rare complication of retina surgery. Ophthalmic Plast Reconstr Surg. 2017;33:e141-e142. doi: 10.1097/IOP.0000000000000879.
• 10. Heerfordt, CF. Über das Emphysem der Orbita. Albrecht von Graefes Arch für Ophthalmol. 1904;58: 123–150. doi: 10.1007/BF01948529.
• 11. Dobler AA, Nathenson AL, Cameron JD et al. A case of orbital emphysema as an ocular emergency. Retina 1993;13:166-168. PMID: 8337501.
• 12. Altay C, Erdoğan N, Uğurlu ŞK, Karasu Ş, Mete BD, Uluç E. Radiologic findings of orbital trauma. Cumhuriyet Med J 2013;Supplement:58-64. doi: 10.7197/1305-0028.1972.
• 13. Fleishman, JA, Beck, RW, and Hoffman, RO. Orbital emphysema as an ophthalmologic emergency. Ophthalmology. 1984;91:1389–1391. doi: 10.1016/S0161-6420(84)34135-5.
• 14. Birrer RB, Robinson T, Papachristos P. Orbital emphysema: how common, how significant? Ann Emerg Med. 1994;24:1115-8. doi: 10.1016/s0196-0644(94)70241-1.
• 15. Cartwright, MJ, Ginsburg, RN, and Nelson, CC. Tension pneumoorbitus. Ophthal Plast Reconstr Surg. 1992; 8: 303–304. doi: 10.1097/00002341-199212000-00013.
• 16. Hopper RA, Salemy S, Sze RW. Diagnosis of midface fractures with CT: What the surgeon needs to know. RadioGraphics 2006; 26: 783-93. doi: 10.1148/rg.263045710.
• 17. Aslan F, Ozen O. Correlation of Clinical Findings With Computed Tomography in Orbital Traumas. J Craniofac Surg. 2019 Oct;30(7):e586-e590. doi:10.1097/SCS.0000000000005583.