Good point, Headsqueeze...
I agree that you should be fully evaluated, which would include a scan of the chest... However (and this is more of a semantic point, rather than specific advice for nataliemay), as you point out, DCS is a catch-all term. Once air gets into the soft tissues, it can and will spread, especially if assisted by pressure. In diving, one would see this on ascent with trapped air. In the hospital, one would see this with- for example- a misplaced tracheotomy tube, in which a ventilator is blowing air into the mediastinum.
In the absence of further pressure gradients (e.g. more diving in the acute recovery phase, which would be contraindicated), the natural history of air trapped in the soft tissues (pneumomediastinum, pneumothorax, or facial empysema) is gradual resorption by the body. I don't know if the small pressure gradient of flying would have much of an effect, but I agree that it would be good to ensure that the trapped air had been absorbed before air travel.
What most divers think of as DCS refers to tiny air bubbles in the circulatory system, which then can cause clinical disease by diffusion into the joints, nervous system, etc... followed by expansion of microscopic bubbles due to dropping ambient pressure (e.g. ascent). Larger volumes of air can be a problem if they compromise circulation in the lungs, or if they cross a defect in the heart and then go through the blood vessels to the brain. And infection can follow the course of the air passage, as Headsqueeze mentioned. This situation, however, is different from a large volume of air trapped in an extravascular space. So while further diving in this situation would be contraindicated, most cases of surgical emphsema that I have seen just resolve on their own. Trapped air in the chest or mediastinum can be a problem if it continues to accumulate and compromises cardiac or pulmonary function, of course, and drainage is sometimes necessary. Again, this usually happens when there is a persistent pressure gradient (e.g. a leak from the airways into the chest).
Your case, nataliemay, is somewhat unique since you had a large pressure gradient pushing air from your nose into your facial soft tissues (and possibly further), probably a higher gradient than even that seen with mechanical ventilation in a hospital setting.
I agree with headsqueeze, though, that a good overall medical evaluation would be appropriate at this point. You don't say if you have had a fever, or if your discomfort is improving, or if there are any other signs of complications...
As far as the blowout fracture goes, if it is a medial blowout, you don't need to fix it at all. If it is an orbital floor fracture, you only need to fix it if you have double vision, if one of the eyes doesn't move well, or if your eyes don't look symmetric (with that eye either displaced down or pushed in). Repair is best done after a few days for swelling to resolve, but by two weeks there can be scar formation which may make it hard to fix. Most ENT plastic surgeons do this anywhere from a few days after the injury to about a week out or so...
I agree that you should be fully evaluated, which would include a scan of the chest... However (and this is more of a semantic point, rather than specific advice for nataliemay), as you point out, DCS is a catch-all term. Once air gets into the soft tissues, it can and will spread, especially if assisted by pressure. In diving, one would see this on ascent with trapped air. In the hospital, one would see this with- for example- a misplaced tracheotomy tube, in which a ventilator is blowing air into the mediastinum.
In the absence of further pressure gradients (e.g. more diving in the acute recovery phase, which would be contraindicated), the natural history of air trapped in the soft tissues (pneumomediastinum, pneumothorax, or facial empysema) is gradual resorption by the body. I don't know if the small pressure gradient of flying would have much of an effect, but I agree that it would be good to ensure that the trapped air had been absorbed before air travel.
What most divers think of as DCS refers to tiny air bubbles in the circulatory system, which then can cause clinical disease by diffusion into the joints, nervous system, etc... followed by expansion of microscopic bubbles due to dropping ambient pressure (e.g. ascent). Larger volumes of air can be a problem if they compromise circulation in the lungs, or if they cross a defect in the heart and then go through the blood vessels to the brain. And infection can follow the course of the air passage, as Headsqueeze mentioned. This situation, however, is different from a large volume of air trapped in an extravascular space. So while further diving in this situation would be contraindicated, most cases of surgical emphsema that I have seen just resolve on their own. Trapped air in the chest or mediastinum can be a problem if it continues to accumulate and compromises cardiac or pulmonary function, of course, and drainage is sometimes necessary. Again, this usually happens when there is a persistent pressure gradient (e.g. a leak from the airways into the chest).
Your case, nataliemay, is somewhat unique since you had a large pressure gradient pushing air from your nose into your facial soft tissues (and possibly further), probably a higher gradient than even that seen with mechanical ventilation in a hospital setting.
I agree with headsqueeze, though, that a good overall medical evaluation would be appropriate at this point. You don't say if you have had a fever, or if your discomfort is improving, or if there are any other signs of complications...
As far as the blowout fracture goes, if it is a medial blowout, you don't need to fix it at all. If it is an orbital floor fracture, you only need to fix it if you have double vision, if one of the eyes doesn't move well, or if your eyes don't look symmetric (with that eye either displaced down or pushed in). Repair is best done after a few days for swelling to resolve, but by two weeks there can be scar formation which may make it hard to fix. Most ENT plastic surgeons do this anywhere from a few days after the injury to about a week out or so...
