title: Subcutaneous emphysema after vigorous sneezing in the setting of acute frontal sinusitis.
abstract: BACKGROUND
  Subcutaneous emphysema [SCE] can develop due to traumatic, infectious, and spontaneous causes and usually localizes to the periorbital space.
  
  
  METHODS
  We present a case of an 18-year-old male with an 8-day history of migraine-like headaches followed by the acute onset of frontofacial swelling after vigorous sneezing. Radiologic and physical exam findings supported a diagnosis of frontofacial SCE in the setting of frontal sinusitis.
  
  
  CONCLUSIONS
  A sneeze, although usually benign, causes a significant increase in intranasal pressure. When coupled with a history significant for facial trauma or rhinosinusitis, this rise in pressure can be sufficient to cause fracturing of the bone overlying a paranasal sinus, leading to the formation of SCE.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, PO Box 980146, Richmond, VA. Electronic address: hirschsd@vcu.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Hirsch
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, PO Box 980146, Richmond, VA. Electronic address: daniel.coelho@vcuhealth.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Coelho
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, PO Box 980146, Richmond, VA. Electronic address: theodore.schuman@vcuhealth.org.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schuman
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012852:Sinusitis / Q000150:complications*; D012912:Sneezing; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology*; D014057:Tomography, X-Ray Computed