Cervicofacial emphysema following unilateral external dacryocystorhinostomies: A case report

Abstract

Cervicofacial emphysema (CFE), mostly seen after trauma or dental procedures, is an unexpected, extremely rare condition after uncomplicated dacryocystorhinostomy (DCR). It may be misdiagnosed as angioedema or necrotizing fasciitis. In this article, we present the case of a 40-year-old female with CFE twice after uncomplicated unilateral DCR for left and right sides on different operative days. CFE was confirmed by computed tomography, demonstrating extensive air within subcutaneous tissues of the face, neck, and orbital cavity. Subcutaneous crepitation supported the diagnosis. This is the first case report, to the best of our knowledge, describing a patient with recurrent massive CFE after each unilateral DCR.

Facial Swelling After External Dacryocystorhinostomy

“…It may also be more likely with more anterior bone removal cre-ating a plane to the subcutaneous tissues of the eyelids. While most cases tend to be self-limiting in nature, 3 there are important exceptions to be aware of. The spread of air can involve the orbits, [4][5][6][7] which can raise the intraorbital pressure and pose immediate risk to the optic nerve, which requires emergency decompression when present.…”

“…Subcutaneous emphysema is a rare but known complication associated with dacryocystorhinostomy. [1][2][3] The connection that is made between the nasal mucosa and the lacrimal sac creates a susceptibility for forced air to become trapped within the subcutaneous tissues. This likely occurs due to disruption in the mucosal barrier following the procedure, which can act as a one-way valve to trap air.…”

“…Subcutaneous emphysema is a rare but known complication associated with dacryocystorhinostomy . The connection that is made between the nasal mucosa and the lacrimal sac creates a susceptibility for forced air to become trapped within the subcutaneous tissues.…”