High-Pressure Injection Injury to the Nare with Extensive Facial Subcutaneous Emphysema: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

High-pressure injection injuries (HPIIs) occur when pressurized devices force air or chemicals through a small skin or mucosal puncture into deep tissue planes. Although the entry site may appear benign, the injectate can rapidly dissect along fascial compartments and cause compartment-like tissue pressure effects, secondary infection, and progressive chemical inflammation and necrosis. Because facial HPIIs are uncommon, management is guided by principles from extremity injuries and limited facial case reports. In this report, we describe a nasal HPII with extensive deep facial emphysema and interval CT progression, yet no necrosis on operative exploration, helping refine thresholds for escalation from observation to surgical evaluation.

A 51 year old male arrived to Butterworth Hospital as a transfer from an outside hospital >12 hours after a high-pressure injection injury to the left nare while working with a petroleum-based oil. CT at the outside hospital demonstrated extensive subcutaneous emphysema affecting the left middle third of the face. Repeat CT on arrival demonstrated progression with deep emphysema tracking from the left nare superiorly to the upper eyelid without violation of the orbital septum, laterally to the parotid region, and inferiorly to the angle of the mandible, within the parotideomasseteric fascial plane.

This case underscores that facial HPIIs can produce dramatic, progressive emphysema that spreads along deep fascial planes. Serial CT imaging with close observation can guide escalation to exploration when progression or threat to critical structures is suspected. However, interval radiographic progression may overestimate tissue compromise, as no necrosis was found during surgical exploration of our patient. An intraoral approach can allow evaluation and irrigation while minimizing cutaneous morbidity.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2147

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