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Orbitopalpebral emphysema is not a very common condition, but when it is found it is always of traumatic origin. Ordinarily it is the result of a fracture of the nasal, lacrimal or ethmoidal bones. It may, however, occasionally be caused by the dentist during the process of drilling the dental canal, as can be seen from the case which I here report. The condition is practically harmless and requires no treatment beyond a pressure bandage.
The diagnosis of the condition is comparatively easy. There is a sudden swelling of the lid and adjacent tissues, with no signs of inflammation, no redness, no pain. The swelling does not pit on pressure, but quickly rebounds, and there is a peculiar crackling sensation felt by the palpating finger, which results from the movement of air bubbles under the fingers. There is no exophthalmos in this variety of emphysema. Exophthalmos is present in emphysema
BRAV A. ORBITOPALPEBRAL EMPHYSEMA CAUSED BY PERFORATION OF A DENTAL CANAL. JAMA. 1915;LXV(15):1275. doi:10.1001/jama.1915.02580150049015