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Imaging Quiz: Blunt Facial Trauma From a Bungee Jump

Steven T. Kmucha, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 5 - MAY 96


[FIGURE 1]A 28-year-old man was brought to the emergency department for severe facial swelling the morning after a bungee jumping accident. The patient had been making jumps nearly every weekend for the past 3 years without injury. This time, he had performed a nighttime jump from a railroad trestle over the gorge of a small river. The height of the bridge at the center of the gorge was about 200 ft, and the river was about 12 ft deep. When the patient jumped, he hit the water face first, plunging under the surface to his waist. The cause of the accident was thought to be a miscalculation of the bridge height.

The patient said that immediately after the jump there had been little evidence of injury aside from mild, diffuse facial swelling, but the next day his face had become so swollen and ecchymotic that he was unable to open his eyes. He said he was unrecognizable to his family, who applied ice compresses before taking him to the hospital. He had no surgical history, did not smoke, took no prescribed or over-the-counter medications, and had no known allergies.

He was in stable condition with no lacerations, abrasions, or other injuries beyond those to his face. Physical exam revealed extreme soft-tissue edema and ecchymosis of the face, tenderness of the nasal dorsum with some bony instability but no displacement of nasal bones, a severe left nasal septal spur, and bilateral tenderness of the anterior maxilla, frontozygomatic suture, and inferior orbital rims. Occlusion and temporomandibular joint function were normal. There was no evidence of facial bone displacement. Otologic exam was normal. An ophthalmology consultation revealed slight restriction of upward gaze in the left eye with diplopia and bilateral subconjunctival hemorrhage. The patient's computed tomography (CT) scan is shown in figure 1.

What's your diagnosis, and what treatment would you recommend?

Dr Kmucha is an attending otolaryngologist at several hospitals in the San Francisco area: Seton Medical Center in Daly City, Peninsula Hospital in Burlingame, Mills Hospital in San Mateo, and California-Pacific Medical Center in San Francisco. He is a clinical instructor in the Division of Otolaryngology-Head and Neck Surgery in the Department of Surgery at Stanford University Medical Center in Stanford, California, and a fellow of the American College of Surgeons. Address correspondence to Steven T. Kmucha, MD, 1800 Sullivan Ave, Suite 604, Daly City, CA 94015.


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