Bartotraumatic Blowout Fracture After Sneezing: Cone Beam CT demonstration

Abstract

Rarely a blowout orbital fracture is related to sneezing in patients with no history of trauma or sinus surgery. A case of barotraumatic, pure and isolated blowout fracture of the right orbit after sneezing diagnosed by CBCT is reported. A forty-year-old man complained sudden right diplopia after vigorous sneezing. On MRI a reduced size and an altered shape of the right maxillary sinus, a slightly increased vertical diameter of the right orbit, a round shape of the inferior rectus muscle on coronal sections, and a right maxillary haemosinus were observed. A strong peripheral enhancement of the maxillary sinus wall was evident. One week after the patient was submitted to a maxillofacial CBCT (90 kVp, 13 mA, 20 s rotation time, FOV 13 x 14.5 cm, 0.25 x 0.25 mm pixel size) at our Institution. A blowout fracture of the orbital floor and lateral orbital wall with an intact orbital rim and a maxillary sinus effusion were detected. The hydraulic theory can explain how hydraulic forces generated during nose blowing or sneezing causes a blowout fracture of the orbital floor. Incarceration of extraocular muscles within an orbital fracture is the most commonly reported cause for diplopia. However it was postulated that traumatic haemorrhage causes swelling of the posterior inferior orbital fat, producing strain on inferior rectus and inferior oblique muscles with consequent diplopia. Radiologists and more generally doctors should be aware that among the causes of sudden diplopia can be also included a barotraumatic blowout fracture of the orbit after sneezing.