Tension pneumo-orbitus and pneumocephalus induced by a nasal oxygen cannula: Report on two paediatric cases

The present paper highlights the potential dangers of misplaced nasopharyng eal oxygen cannulae causing secondary pneumo-orbitus and pneumocephalus in two paediatric patients. While this complication is uncommon, early recogni tion allows prompt and appropriate intervention, with cessation of nasal ox ygen, cannula removal, early investigation with computed tomography (CT) he ad/orbit scan and orbital or cranial decompression, if required. Early CT i maging identifies medial orbital or paranasal sinus fractures, the presence of sinusitis, associated intracranial air and assessment of the degree of orbital or intracranial tension. Antibiotics are not usually required for t his type of clean injury unless pre-existing sinusitis is identified. In bo th cases, direct orbital decompression was performed with excellent results after identification of marked unilateral tense exophthalmos, delayed pupi llary reactions to light and ophthalmopegia.