|Year : 2018 | Volume
| Issue : 3 | Page : 136-138
Lamina Papyracea Breach: Brunt of Amateur Kabaddi
Basavaraj P Belaldavar, JS Tejaswini, Paramita Debnath
Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
|Date of Web Publication||28-Jun-2019|
Dr. J S Tejaswini
Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
The game of Kabaddi requires offensive and defensive skills that include consideration of the raid, taking cant and entry, tracing the path, footwork, attacking tactics, and returning back which makes the players prone to many types of sports-related injuries. It being a contact game many body parts are prone to injuries in which isolated orbital fractures are uncommon. Orbital emphysema is a clinical situation in which air gets trapped in the orbital adnexa. This happens invariably secondary to orbital blunt trauma where there is a breach of lamina papyracea which is well documented but has not merited much attention.
Keywords: Fracture medial wall orbit, Kabaddi, orbital emphysema
|How to cite this article:|
Belaldavar BP, Tejaswini J S, Debnath P. Lamina Papyracea Breach: Brunt of Amateur Kabaddi. J Sci Soc 2018;45:136-8
| Introduction|| |
Orbital emphysema is a relatively uncommon clinical situation in which air gets accumulated in the orbit and/or eyelid as a result of blunt trauma breach in the continuity of confinement of eye socket, that is, because of the breach in one of the orbital bones. May also be secondary to injury from compressed air hoses, infection, pulmonary barotrauma, complication of operation, airplane travel, and Boerhaave's syndrome. However, it assumes importance when complications occur such as infection or loss of vision because of pressure effects. We report a very interesting case of orbital emphysema in a young man because of Kabaddi injury.
| Case Report|| |
A 22-year-old male patient presented to the department of emergency medicine with the left eyelid swelling 2 days after he was playing Kabaddi and was injured in his left eye by a fellow player's knee. Following the impact, the patient had accidentally blown his nose after which his eye became “puffed out” and was unable to open his eyes. He did not give a history of headache, nausea, vomiting, dizziness, nasal congestion, or bloody discharge from his nose or eye. On physical examination, vital signs were normal. On local examination, there was nontender periorbital swelling, ptosis, and ecchymosis around the left eye with conjunctival chemosis, and palpebral fissure was not visualized. Eyelashes were matted with mucoid discharge [Figure 1]. Ophthalmology reference was sought for. There was no proptosis, and the remaining examination was normal including vision, extraocular motion, and pupillary reflex. Computed tomography showed accumulation of air in the left orbit and an isolated medial orbital wall fracture and left ethmoid hemosinus [Figure 2] and [Figure 3]. Ice pack application, avoidance of nose blowing, straining, and sneezing were advised. Empiric antibiotic and nonsteroidal anti-inflammatory drug treatment were prescribed.
|Figure 1: At the time of presentation. Note the left periorbital swelling with ecchymosis and ptosis|
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|Figure 2: Computed tomography is the investigation of choice: coronal and axial cuts: Red arrow showing accumulation of air in the left orbit and an isolated medial orbital wall fracture. But no evidence of entrapment as there was no problem in eye movements|
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|Figure 3: X-ray on day 1: Black eyebrow sign is the description given on plain facial radiographs to intraorbital air. Red arrow shows air density around the left superior orbital margin, suggestive of orbital emphysema|
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The patient came for follow-up after 2 weeks with resolution of the symptoms and signs [Figure 4] and [Figure 5].
| Discussion|| |
Kabaddi has been an ancient backyard game played with minor variations in all regions of India – in fact, in most parts of Asia. Kabaddi requires tremendous physical stamina, individual proficiency, neuromuscular coordination, agility, quick reflexes, intelligence, and presence of mind on the part of both attackers and defenders. Nature of individual defense and group offense of the sport makes Kabaddi players prone to many types of injuries. Knee injury is the most common type of injury sustained by both “raiders” and “stoppers/defenders,” which accounts for 19%. Next comes the injury to ankle which accounts for 14% and then the facial injuries in which isolated orbital fracture is uncommon.
Although the medial wall (lamina papyracea) is thinner (approximately 0.25-mm thick) than the orbital floor (approximately 0.5-mm thick), fractures of the orbital floor are most common, whereas isolated medial wall fractures occur only in approximately 10%–30% of cases of orbital trauma.
The detailed description of orbital emphysema was accounted first in 1904 by Heerfordt. His classification system included (1) palpebral emphysema, (2) true orbital emphysema, and (3) orbitopalpebral emphysema.
True orbital emphysema is an abnormal collection of air posterior to an intact orbital septum. Most commonly, this condition occurs due to fracture of one or more of the bony orbital walls and laceration of the adjacent sinus mucosa, the two factors that allow communication of a sinus with the orbit. Frequently, this involves the fracture of ethmoid air cells and a break in the fragile lamina papyracea. Notably, the entrance of air into the orbit does not occur spontaneously with the fracture but rather occurs intermittently when the pressure within the upper respiratory passages is increased (for example, with nose blowing or sneezing). Air is trapped in the periorbital spaces when the orbital soft tissue acts as a ball valve and presses back the fracture fragment or herniates into the sinus cavity.
Orbital emphysema resolves on its own as the air is absorbed [Figure 4] and [Figure 5]. Surgical repair of orbital fractures within 2 weeks is indicated in patients with diplopia and computed tomography evidence of entrapped muscle or periorbital tissue, large fractures (>50% of the wall), and enophthalmos that does not resolve. Entrapment of soft tissue may stimulate the oculocardiac reflex, causing strong vagal responses including bradycardia, nausea, vomiting, syncope, and heart block. In these cases, rapid repair and release of entrapped soft tissues is recommended. If there is suspicion for orbital compartment syndrome, emergency decompression is necessary and either canthotomy/cantholysis or needle aspiration of trapped air is typically performed.
| Conclusion|| |
- The lamina papyracea fracture secondary to nose blowing can cause orbital emphysema
- Careful observation is the only treatment necessary unless an orbital wall fracture involves an infected sinus, in which case prophylactic orally administered antibiotics may be prescribed.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zimmer-Galler IE, Bartley GE. Orbital emphysema: Case reports and review of the literature. Mayo Clin Proc 1994;69:115-21.
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Heerfordt CF. About the emphysema of the orbita. Albrecht Von Graefes Arch Ophthalmol 1904;58:123-50.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]