Mediastinal emphysema secondary to fracture of orbital floor

An unusual case of blowout fracture of the orbit is presented. The possibility of massive surgical mediastinal emphysema has not been well pointed out in the literature previously nor has it been associated with pure blowout fractures. The mechanisms of its development have been explained and other causes of mediastinal emphysema eliminated. In the traumatized patient with blowout fractures, this may possibly be an associated finding. A plausible but unsubstantiated explanation was offered for the bradycardia and hypotension that were present during the massive subcutaneous emphysema around the neck.