Camouflaging Facial Emphysema: a new syndrome.

Camouflaging Facial Emphysema, as is defined in this paper, is the result of a simple technique used by the patient to deform his face in order to prevent recognition at a police identity parade. The patient performs two punctures in the mucosa at the rear of the upper lip and, after several Valsalva manoeuvres, manages to deform his face in less than 15 min by inducing subcutaneous facial emphysema. The examination shows an accumulation of air in the face, with no laterocervical, mediastinal or thoracic affectations. The swelling is primarily observed in the eyelids and the orbital and zygomatic regions, whereas it is less prominent in other areas of the face. Patients therefore manage to avoid recognition in properly conducted police identity parades. Only isolated cases of self-induced facial emphysema have been reported to date among psychiatric patients and prison inmates. However, the facial emphysema herein described exhibits specific characteristics of significant medical, deontological, social, police-related, and legal implications.