Periorbital Emphysema

If a breach in the lamina papyracea occurred at surgery and the patient has blown their nose in the first 4 days or stifled a sneeze (this dramatically increases the intranasal pressure), this can force air into the soft tissues around the eye (Fig. 12.24). If the surgeon recognizes that there is a defect in the lamina papyracea, the anesthetist should be advised to take care after extubating the patient and not to use too much force if the patient needs to be ventilated with a facemask (in other words, do not have a fixed valve on the circuit). If emphysema occurs, it will resorb, provided the patient does not blow any more air into the area. Prophylactic antibiotics are given in order to avoid periorbital cellulitis.

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