When can patients blow their nose and fly after treatment for fractures of zygomatic complex: the need for a consensus

Mahmood, Shaukat; Keith, D.J.W.; Lello, Glenn E.

doi:10.1016/s0020-1383(03)00057-3

Cited by 15 publications

(11 citation statements)

References 6 publications

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“…However, bone callus may be observed replacing cartilage approximately 2 to 3 weeks after the initial fracture [12]. Although difficult to definitively conclude that bone callus at this stage possesses sufficient structural integrity, it does reinforce recommendations by some of the OMFS in the Mahmood et al study [11].…”

Section: Discussionmentioning

confidence: 99%

“…Since there is a heightened concern for complications with a pilot, it is important to arrive at a more definitive answer to when a return to flying is considered appropriate and safe. A study by Mahmood et al [11] attempted to answer this question by surveying 184 oral and maxillofacial surgeons (OMFS) in the UK and asking them how long they recommend patients to refrain from nose blowing or travel by airplane after suffering zygomatic complex fractures. Their results showed a wide variation: 40% of OMFS made no recommendations, 30% recommended avoiding air travel for 8 to 14 days, and 15% for 3 to 8 weeks.…”

Section: Discussionmentioning

confidence: 99%

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Water balloon-induced orbital fracture in an aviator

Holland¹,

Smith²,

Gibson³

et al. 2019

Military Med Res

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Background Orbital fractures are common injuries found in facial trauma. Typical etiologies of orbital fractures include motor vehicle collisions and assault. We report the case of a 32-year-old male who suffered an orbital fracture from a water balloon. Additionally, we describe the aeromedical complications that may result from this injury. Finally, we attempt to answer the question of when a patient may return to flying after sustaining such an injury through review of the literature. Case presentation A 32-year-old male pilot with the United States Air Force was at an outdoor event with his unit when he was struck with a water balloon launched from a sling shot into his left orbit. Shortly afterwards, he had an onset of subcutaneous emphysema and was escorted to a nearby Emergency Department. Computed tomography identified an orbital fracture with associated orbital and subcutaneous emphysema. The patient was evaluated by a plastic surgeon and was determined not to be a surgical candidate. Four weeks later, he returned to flying status. Conclusions Water balloons are thought to be safe and harmless toys. However, when coupled with slingshots, water balloons can become formidable projectiles capable of significant orbital injury including orbital fractures. These injuries are concerning to aviators, as the most common sites for fractures of the orbit are the thin ethmoid and maxillary bones adjacent to the sinuses. At altitude, gases in the sinuses may expand and enter the orbit through these fractures, which may suddenly incapacitate the flyer. It is important for flight surgeons to identify and assess these individuals to determine suitability for flying.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Water balloon-induced orbital fracture in an aviator

Holland¹,

Smith²,

Gibson³

et al. 2019

Military Med Res

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“…A study from UK had evaluated the recommendations of 184 oral and maxillofacial surgeons to patients with zygomatic complex fractures regarding the required post-injury period of avoidance air travels. 90 The outcomes of study did not provide evidence-based recommendations, with a significant percentage (40%) of participants did not indicate a specific timeframe. 91 Some authors have suggested 4 weeks of avoiding air for small orbital fractures with minimal displacement.…”

Section: Discussionmentioning

confidence: 92%

“…91 Some authors have suggested 4 weeks of avoiding air for small orbital fractures with minimal displacement. 90 Due to the fact that bone callus is typically formed approximately 2 to 3 weeks after fracture, it can be hypothesized that structural integrity is achieved. 89…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum as a Complication of Oral and Maxillofacial Injuries: Report of 3 Cases and a 50-Year Systematic Review of Case Reports

Papadiochos

Sarivalasis

Chen

et al. 2021

Craniomaxillofacial Trauma & Reconstruction

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Objectives: Pneumomediastinum (PM) secondary to oromaxillofacial trauma (OMF) is a rare but well-described complication/pathologic finding. The aim of this study was twofold: first, to report our experience in treatment of maxillofacial trauma patients with PM, and second, to review the literature regarding the clinical features, severity, course, and management of the aforementioned complication. Material and methods: We retrospectively reviewed the medical records and charts of patients who suffered from maxillofacial trauma and treated in our hospital between September 1, 2013 and September 31, 2017. The inclusion criteria were patients with radiologically confirmed PM. In addition, the electronic databases PubMed, Scopus, and Science Direct were queried for articles reporting PM cases secondary to OMF injuries and published in English, French, and German language. Results: Three cases of PM out of 3,514 cases of craniomaxillofacial trauma were found; there were 3 male patients who presented in our emergency department with the chief complaint of cervicofacial swelling. Literature search isolated 58 selected articles and 63 cases were assessed in total; posttraumatic repeated blowing of nose was proved as most frequent triggering factor among them. Furthermore, the outcomes of review showed that thoracic pain, respiratory distress, and swallowing difficulties were not frequently reported in patients with ME due to facial trauma. Conclusions: Both our experience and the results of systematic literature review indicated that patients with PM due to OMF injuries present mild clinical course. If properly managed, this specific pathologic condition may have no further complications or relative comorbidities. The exact etiology and mechanism of PM in the context of maxillofacial injuries always needs to be identified. Radiographic, laboratory, and endoscopic examinations should be applied to rule out the more serious and frequently diagnosed aerodigestive, thoracic, and abdominal causes of PM.

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“…1,2 Practice surveys indicate that the majority of surgeons recommend avoidance of air travel in the post-injury period due to concern regarding the possibility that the reduction in atmospheric pressure encountered during aircraft ascent may exacerbate orbital emphysema and produce visual compromise. 2,3 This concern has been driven, in part, by a number of commonly cited case reports of visual loss with changes in altitude, as well as extrapolation from descriptions of compartment syndrome developing due to orbital emphysema. 4,5 Despite this, there have been no previous reviews on the evidence regarding the safety of flying with a fracture of the orbit, and current practice varies widely in terms of the length of time for which patients are advised to avoid flying.…”

mentioning

confidence: 99%

Orbital Fractures and Air Travel

Riordan

Rijt

Kernohan

2021

Journal of Craniofacial Surgery

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Previous surveys indicate that the majority of clinicians recommend avoidance of air travel for a period of time following an acute orbital fracture. This advice has largely been based on the theoretical risk that in-flight pressure variation may exacerbate orbital emphysema and produce visual compromise, though no previous reviews have been conducted on the evidence underpinning this advice. The purpose of this study was, therefore, to conduct a systematic review of the literature pertaining to the safety of air travel in the setting of an acute orbital fracture. A systematic review of the OVID Medline database -and of cases referenced as providing evidence for adverse outcomes due to flying with an orbital fracturewas carried out.Two articles were identified from the literature with data specific to patients who undertook air travel following orbital fractures. A large case series identified no complications in patients exposed to both pressurized and unpressurized air travel, and only a single case report detailed an adverse outcome requiring intervention. The remainder of the articles that had previously been cited as evidence against air travel involved additional factors such as intraocular pathologies. There is, therefore, a paucity of evidence to support the conventional advice regarding avoidance of air travel, though clinicians should exclude the possibility of an associated intra-ocular injury, advise against nose-blowing in flight, and provide advice regarding alternative methods to the Valsalva maneuver for equalizing middle ear pressure in flight. Level of Evidence: IV

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When can patients blow their nose and fly after treatment for fractures of zygomatic complex: the need for a consensus

Cited by 15 publications

References 6 publications

Water balloon-induced orbital fracture in an aviator

Water balloon-induced orbital fracture in an aviator

Pneumomediastinum as a Complication of Oral and Maxillofacial Injuries: Report of 3 Cases and a 50-Year Systematic Review of Case Reports

Orbital Fractures and Air Travel

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