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The authors wish to discuss the possibilities and pathophysiology of orbital emphysema of a live victim of high-explosive blast attack. A 35-year-old male suffered a terrorist blast resulting in shrapnel injuries, flash-burns and bilateral ear drum perforation. Throughout in a conscious and rational state, he was taken to the nearest tertiary-care hospital. Two shrapnels were surgically removed and all external injuries cleaned and dressed. Swollen left eye was examined by the ophthalmologist to reveal unilateral subcutaneous emphysaema and diplopia but no orbital wall fracture was detected. Specialized ENT referral revealed bilateral central eardrum perforation with impaired hearing. Treating clinicians have already attributed all injuries to the effects of the blast, by the time the Forensic Specialists examined the patient for medico-legal purposes. The forensic specialists were reluctant to attribute orbital emphysema to the effects of the initial blast. Detailed history from the examinee revealed an incident of forceful and violent nose-blowing immediately after the blast to relieve the abnormal sensation he felt within his ears. We discuss here the pathophysiology of orbital emphysema and possible mechanisms of its causation. In conclusion, we emphasize the need for careful interpretation of injuries specially in complex situations such as bomb blasts to prevent attribution of erroneous aetiological factors.
Forensic Explosion Investigation and Analysis - Forensic Experts [Internet]. Forensic Experts; 2020. [Cited 31 May 2020] Available:http://www.forensicexperts.com.sg/forensic-explosion-investigation-and-analysis
Khurana P, Dalal JS. Bomb blast injuries. J Punjab Acad Forensic Med Toxicol [Internet]. 2020;11(1):37-39. Available:https://www.researchgate.net/publication/281739779_Bomb_blast_injuries
Wolf S, Bebarta V, Bonnett C, Pons P, Cantrill S. Blast injuries. The Lancet. 2009;374(9687):405-415. DOI: 10.1016/S0140-6736(09)60257-9
Rossi T, Boccassini B, Esposito L, Clemente C, Iossa M, Placentino L, et al. Primary blast injury to the eye and orbit: Finite element modeling. Investigative Opthalmology & Visual Science [Internet]. 2012. 2020;53(13):8057. Available:https://iovs.arvojournals.org/article.aspx?articleid=2165452. doi:https://doi.org/10.1167/iovs.12-10591
Brahmaji Master P, Chandra Sekhar V, Rangaiah YKC. Bomb Blast: Pattern and Nature of Injuries. Journal of Evidence based Medicine and Healthcare. 2015; 2(2):165-171. DOI: https://doi.org/10.1186/s13017-018-0164-7
Uyank LO, Aydn M, Buhara O, Ayali A, Kalender A. Periorbital emphysema during dental treatment: A case report. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology [Internet]. 2011;112(6): e94–6. Available:http://dx.doi.org/10.1016/j.tripleo.2011.05.036.
Sen D, Chaturvedi PK. Orbital emphysema after sneezing: A case report. Med J Armed Forces India [Internet]. 2011;67(3): 282–4. Available:http://dx.doi.org/10.1016/S0377-1237(11)60063-4
Abbotts R, Harrison S, Cooper G. Primary blast injuries to the eye: A review of the evidence. Journal of the Royal Army Medical Corps. 2007;153(2):119-123. Available:https://doi.org/10.1136/jramc-153-02-10
Ritenour AE, Baskin TW. Primary blast injury: update on diagnosis and treatment. Crit Care Med. 2008;36(7 Suppl): S311-S317. DOI:10.1097/CCM.0b013e31817e2a8c
Chan HY, Lio CF, Yu CC, Peng NJ, Chan HP. Spontaneous orbital subcutaneous emphysema mimicking lacrimal duct obstruction after sneezing: A case report. Hong Kong J Emerg Med. 2018;5–8. Available:https://doi.org/10.1177/1024907918797530
Zimmer-Galler IE, Bartley GB. Orbital Emphysema: Case reports and review of the literature. Mayo Clin Proc [Internet]. 1994;69(2):115–21. Available:http://dx.doi.org/10.1016/S0025-6196(12)61036-2
Koenen L, Waseem M. Orbital Floor (Blowout) Fracture; 2020. [Internet]. Ncbi.nlm.nih.gov. 2020 [Cited 1 June 2020] Available:https://www.ncbi.nlm.nih.gov/books/NBK534825/. PMID: 30521246 NBK534825