 Facial Injuries Ear, Eye, Nose, & Mouth

The Ear  The ear allows us to hear and maintain balance/equilibrium.  3 sections:  Outer Ear  Middle Ear  Inner Ear

The Outer Ear  Known as the Auricle or Pinna  Made up of cartilage  The pinna leads into the external auditory canal and ends at the eardrum or tympanic membrane.

The Middle Ear  Middle Ear or Tympanic cavity.  Between the tympanic membrane (eardrum) and the inner ear, and leads to the eustachian tube.  This tube conducts sound to the inner ear by passing sounds vibrations.  The eustachian tube allows the air pressure in the middle ear to equal the air pressure entering the external auditory ear canal, keeping the pressure on both sides of the tympanic membrane equal.

The Inner Ear  The most important and complex.  Cochlea – holds the sensory receptors for hearing.  Vestibule and Semicircular Canals – receptors for equilibrium and sense of position.  These canals contain fluid that moves in response to head and body movements.

Injuries to the Ear Any forceful blow to the side of the head can affect one’s balance as well as one’s ability to hear. In sports, injuries to the ear usually involve the external ear. Prevention - Wear proper equipment and remove earrings prior to play.

Cauliflower Ear Hematoma auris. Common in wrestling and boxing. Caused by extreme friction or repeated trauma to the ear. S&S: tearing of the cartilage in the external ear, which results in bleeding and fluid accumulation around the ear.

Treatment  Immediate Treatment: Apply ice, compression, and put a bandage on the ear. Refer to physician for follow up care. If the injured athlete experiences hearing loss immediately following injury, refer immediately.  Follow Up Treatment: Check for signs of infection, keep protected.  Prevention: Wear proper protection – head gear, helmets. Apply skin lube to reduce friction.

Otitis Externa (Swimmer’s Ear)  An infection of the ear canal.  Occurs when moisture is trapped in the external ear canal by accumulation of wax, a foreign object, swelling, or some other blockage.  Frequently affects swimmers.  S&S: Dizziness, pain, itching, discharge, and partial hearing loss.

Treatment  Immediate Treatment: Dry the ear thoroughly, ear drops, and referral to Dr.  Follow-Up Treatment : Follow Dr.’s orders.  Prevention: Advise athletes to dry the ears thoroughly and use ear drops containing 3% boric acid and alcohol solution before and after swimming. Rubber or wax ear plugs to keep water out of the ear.

Rupture of the Tympanic Membrane  Rupture of the eardrum.  Contact sports and diving.  It can be ruptured:  As a result of sudden change in pressure  Blunt trauma to an unprotected ear  By an object that inserted to far into the ear  S&S: Loud pop, pain, dizziness, hearing loss, nausea, vomiting. Bleeding and tinnitus may occur.

Treatment  Immediate Treatment: Refer to Dr. immediately. The injury will heal in about two weeks. Needs to be monitored for infections and further injury. Removal from aquatic sports.  Follow-up Treatment: Monitor for signs of infection. Do not return to play without permission from Dr.  Prevention: Wear ear protection in contact sports, especially wrestling.

 Injuries to the Eye

Anatomy of the Eye  Spherical in shape.  Very delicate.  Orbit = eye socket.  Eyelid and eyelashes protect the eye by helping keep out foreign objects (dust, dirt, pathogens).

Anatomy of the Eye  Surrounded by three layers of protective tissue.  Inner layer is the Retina, contains nerve receptors for vision.  Cornea – clear front portion of eye (sensitive to injury).  In sports the eyes are vulnerable to trauma – impact with fingers, elbows, sport objects, etc.

Anatomy of the Eye

Contusions  “Black eye” or “Racoon’s eye”  A blow to eye may cause a contusion

WARM UP  ________ is the most common injury of the ear in sport activity. It is caused by extreme friction, or repeated trauma to the ear. Often occurs in wrestling and boxing.  _______ is an infection in the ear canal.  Inflammation of the membrane lining the eyelid is known as _________.  Bleeding within the anterior chamber of the eye is called?  An ___________ fracture is a fracture of the bone forming the roof of the eye.  A blow to the eye may cause a _____________ if there is bleeding in the blood vessels around eye.

Injuries to the Eye  Contusions  Corneal Abrasions and Lacerations  Retinal Detachment  Orbital Fracture  Foreign Bodies in the Eye  Conjunctivitis  Sty  Hyphema  Ruptured Globe

 Injuries to the Nose

The Nose  Composed mostly of soft tissue.  Susceptible to injury during sports because of its location.  Composition of bone, cartilage, and skin that protects the frontal bone and maxilla.  Nostrils – the openings to the nasal passage.  Nasal septum – area of bone and cartilage that separates the two nostrils.  Serves as the air passage between the nostrils and the throat.  Also serves as the organ of smell.

Injuries to the Nose  Epistaxis = Nosebleeds  Caused by direct blows to the nose.  Treatment:  Control bleeding using direct pressure  Ice or cold compress  Never tilt the head back (Choking)!  Have the athlete sit upright, lean forward and pinch the nose.  Insertion of nose plug or tampon (cut in half). Do NOT insert too far. Leave some protruding from the nose for easy removal.  Referral if bleeding lasts longer than 5 minutes.

Treating Epistaxis

Nasal Septal Deviation  When a blow to the nose causes the septum to shift.  Decreases the athlete’s ability to breath through one of the nasal passageways.  S&S: Pain, bleeding, decreased air movement through one nostril.  Treatment: Referral  Protective gear if continuing to play sports.

Deviated Septum

Nasal Septal Hematoma  Septum = The area of cartilage between the nostrils.  If trauma occurs to the face, and the septal area becomes bruised, swollen, red, painful, or infected a Septal Hematoma may occur.  Bleeding between the septum and the mucous membrane.  S&S: (Similar to a fracture) Blocked nasal passage by swollen tissue, forcing the athlete to breath through the nose.  Treatment: Control bleeding, ice, maintain an open airway, do not lie down or tilt head back (can cause choking).

Nasal Septal Hematoma

Nasal Fractures  Occur frequently in sports.  Can result from straight on or side force blow against the nose.  S&S:  Deformity  Crepitation  Sometimes epistaxis  Swelling  Pain  Ask the athlete to look in the mirror to see whether they think their nose is in it’s normal alignment.

Nasal Fractures

Prevention of Nasal Injuries  Wear a Facemask or Nose guard during for sports or certain positions that are at high risk!!  Football  Field Hockey  Hockey  Lacrosse  Goalies  Softball Pitchers

WARM UP  The result of an infection of the eyelid follicle or the subcutaneous gland is called a ___________.  The septum is the area of _________ between the _________.  A nosebleed is also called _____________.  What is the proper treatment of a nosebleed?  What are three symptoms of a nasal fracture?  How do you prevent nasal injuries?

 Injuries to the Mouth and Jaw

Temporomandibular Joint Dislocation  The jaw is prone to dislocation because of its wide range of motion.  Can occur from a side blow to an open mouth.  S&S: Jaw locked in an open position.  An overbite of the teeth.  Pain and deformity.  May prevent the athlete from being able to the move the jaw to speak.  Do NOT attempt to relocate the joint in place. There could also be a fracture and movement can make the fracture worse.

TMJ Dislocation

Jaw Fractures  Fractures to the mandible or maxilla.  Result from a direct blow to the jaw.  S&S: Bony displacement, abnormal movement, loss of normal bit or overbite (malocclusion), pain with movement, bleeding around the teeth, numbness of the lower lip, point tenderness.  The jaw may be “locked” in an open position.

Jaw Fractures

Dislocations/Fractures of the Teeth  Displaced, fractured (chipped), or dislocated (knocked out).  Bleeding from an exposed tooth socket will indicate a missing tooth.  Treatment:  If a tooth is dislocated (knocked out), clean the tooth with water and if possible place it back into the gum. Maintain pressure on the tooth to keep it in place and then send the athlete to the dentist.

Treatment Continued  If unable to replace the tooth back into the gum, wrap the tooth in moist, sterile gauze and send with the athlete to the dentist.  If the tooth is not replaced within 30 minutes the chances of saving the tooth decline rapidly.  For fractures of the teeth, carefully remove any loose bony fragments that may impede the airway and refer to the dentist.  Rare, but is possible for a dislodged tooth to be aspirated into the lung.  Sometimes displaced teeth are accompanied by a fracture jaw or concussion.

Teeth Injuries