Early Aeromedical Evacuation for Orbital Emphysema After Zygoma and Orbital Floor Fractures

Aeromedical evacuation of patients with post-traumatic orbital emphysema following zygoma and orbital floor fractures has often been viewed with considerable concern. The expansion of intra-orbital air with increasing altitude can theoretically result in orbital tension, which can lead to blindness. This concern is mainly based on extremely rare case reports and theoretical models rather than significant clinical experience. The purpose of this work is to evaluate hazards and complications associated with aeromedical evacuation of combat casualties with post-traumatic orbital emphysema following zygoma and orbital floor fractures.

We report the results of a series of 12 patients with post-traumatic orbital emphysema who were evacuated from a combat theater by military aircraft over a long distance. All military patients referred to a military hospital in France with CT-identified zygoma and/or orbital floor fracture repatriated via tactical aeromedical intervention from January 2020 to January 2022 were analyzed. An ophthalmological examination with visual acuity measurement and a new CT scan of the facial mass without injection were performed after evacuation.

There were 12 patients referred. None of the patients had any complications. Only one soldier, who blew his nose during the trip, had an increase in subcutaneous emphysema without any impact on his vision. There was one minimal displacement of the fracture secondary to a nose blowing without significant impact.

Orbital emphysema in facial injuries is not likely in itself to be a contraindication to immediate air evacuation in the case of zygoma and orbital floor fracture. Crambert A, Ballivet de Regloix S, Haen P, Morvan J-B, Caruhel J-B. Early aeromedical evacuation for orbital emphysema after zygoma and orbital floor fractures. Aerosp Med Hum Perform. 2026; 97(1):55-59.