Injuries to the Head and Face Injuries, Evaluation, and Management

Head and Facial Injuries Usually occur due to direct trauma Head is divided into two categories Cranium – includes brain, skull, spinal cord attachments Face – includes eye, nose, mouth, ears, and jaw

Eye Injuries Injury Corneal Abrasion Contusion Cut or Puncture Hyphema Conjunctivitis Orbital Fracture Basic Info S/S Tx Rehab/ RTP Corneal Abrasion-scratch or cut caused by dirt or foreign object (sand, metal, fingernail, contact lens) S/S – Pain or “itchy” feeling in eye Tx – Avoid rubbing eye, if object found, rinse with clean water or saline; if not, see physician Rehab/RTP – RTP is ok when object is removed and athlete can participate without discomfort Contusion- “Black eye” occurs from direct trauma or sign of head injury S/S – pain, swelling, discoloration Tx- Ice 15 minutes every hour, monitor eye itself for discoloration Rehab/RTP – when cleared by staff, protective eyewear until healed Cut/Puncture- Wounds penetrating the eye are rare in athletics, but lacerations to eyelid are more common S/S – bleeding Tx – to the eye- cover without pressure; to the eyelid, pressure is ok; likely need sutures/steri-strips Rehab/RTP- with physician approval and protective eyewear Hyphema- bleeding in anterior chamber of eye, usually caused by blunt trauma S/S- decreased vision in initial stage; when blood settles, vision will improve; obvious redness Tx- should be seen by ophthalmologist to monitor reabsorption of blood Rehab/RTP- no activity until complete reabsorption, and cleared by ophthalmologist Conjunctivitis- “pink eye” infection of outer layer of eye; can be viral, allergic, and bacterial S/S- discomfort, redness, inflammation, pain, discharge Tx- allergic= cold compresses, artificial tears, antihistamines; bacterial= antibiotics; viral= no cure Rehab/RTP- when cleared by physician (no longer contagious) Orbital Fracture- fracture to the bones of the eye socket, usually from trauma from object large than orbital entrance. S/S- severe pain, tenderness around eye, swelling, double vision, pain with eye movement, protrusion of eye and cheek numbness is also possible Tx- bandage/cover both eyes, apply ice (little/no pressure), seek medical care immediately Rehab/RTP – must be cleared by physician, will require protective eyewear for all future participation

Eye Injuries Diagrams/Illustrations:

Ear Injuries Injury Cauliflower Ear Swimmer’s Ear Foreign Body Tympani Rupture Basic Info S/S Tx Rehab/RTP Cauliflower Ear – thickening of outer ear due to collection of blood between cartilage and skin, usually from repeated trauma S/S – skin separates from cartilage giving “cauliflower” appearance Tx – drained by physician followed by immediate and moderate compression RTP – determined by physician; headgear must be worn Swimmer’s Ear – infection of the skin covering the outer ear canal; occurs when water gets trapped in canal due to wax build-up and bacteria grows. S/S – ear feels “full” and itchy, pain; in severe cases, canal can swell shut and can be difficult to open jaw Tx – ear should be kept dry, earplugs to be worn in the water RTP – allowed after treatment has begun and steps are taken to minimize exposure of ear canal to water Foreign Body – when an object gets lodged in the ear canal; rare in athletics outside occasional insect S/S – pain, itching, drainage, dizziness Tx – flushing of ear canal can sometimes remove object, otherwise removal with specially designed tools RTP – may rtp immediately Tympani Rupture – rupture of eardrum either by trauma or secondary to ear infection S/S – severe ear pain, sudden drainage that has foul odor Tx – Immediate referral to physician is necessary; antibiotics to minimize enfection RTP – upon physician clearance; usually 1-2 weeks

Ear Injuries Diagrams/Illustrations:

Nose Injuries Injury Epistaxis Nasal Fracture & Septal Deviation Basic Info S/S Tx Rehab / RTP Epistaxis – nosebleed; rupture of blood vessels inside nasal cavity, usually from direct trauma S/S – discharge of blood from the nose Tx – control bleeding – pinch nose just below bridge, tilt head FORWARD, and cover with gauze/padding; ice if bleeds longer than 10 minutes RTP – can return after packing the nasal cavity Nasal Fracture/Septal Deviation – Fx= break of the nasal bone; septal deviation= cartilage below the bone is dislodged and moved laterally; occurs from direct trauma S/S – deformity; pain, swelling, lacerations, epistaxis; eccymosis Tx – control bleeding with careful pressure, apply ice to minimize swelling, and refer to physician for further care of fracture RTP – after clearance by physician; will likely require face mask to protect nose from further injury

Nose Injuries Diagrams/Illustrations:

Mouth/Jaw Injuries Injury Jaw Fracture TMJ Injury (Temporomandibular) Tooth Injuries Basic Info S/S Tx Rehab / RTP Jaw Fx – Fx to the mandible; usually a secondary fx, close to the TMJ due to the thin section of bone and the force driven toward the jaw’s attachment S/S – severe pain, swelling, blood at base of teeth closest to fx site, pain upon biting down Tx – immobilization of athlete, ice, tx for shock, immediate referral to physician RTP – must be cleared by physician, will likely wear protective face shield in the future TMJ Injury – affected by action on joint on contralateral side and relationship of where the teeth meet S/S – dislocation will result in inability to close the mouth, deformity, swelling; sprains will result in pain and popping feeling when opening and closing mouth Tx – ice and referral to physician RTP – may be required to wear mouthpiece (generally ordered to help malaligned jaw) Tooth injuries – most common facial injury sustained during participation in sports; usually either broken tooth or dislodged tooth S/S – pain in teeth and in gums anchoring the involved tooth; if broken, will be an obvious fracture Tx – if knocked out or hanging, place back in socket and maintain pressure; if unable, wrap in sterile wet gauze or soak in athlete’s saliva until athlete can get to dentist RTP – mouthguard will be required but will likely return to sport quickly

Mouth/Jaw Injuries Diagrams/Illustrations:

Head Injuries Injury Scalp Laceration Skull Fracture Concussion Hemorrhage Second Impact Syndrome Basic Info S/S Tx Rehab/ RTP Laceration – cut to the superficial tissue surrounding the skull S/S – profuse bleeding (due to high vascularization), underlying injury may also cause hematoma Tx – control bleeding (direct pressure) **Ensure no skull fx is present before placing significant pressure on laceration; will likely be steri-stripped, or sutured by physician RTP – physician or neurologist will determine Skull Fx – various types (linear, depressed); major concern is to ensure no fragments lacerate brain tissue S/S – bleeding or CSF draining from ear or nose Tx – Immobilized, treatment for shock, immediate EMS activation; light gauze to cover any bleeding RTP – Extended period of time, will need clearance from neurologist/physician Concussion – SKIP – WILL COME BACK TO LATER Hemorrhage – intracranial bleeding, 3 types: Subdural hematoma (results from tearing of small veins under dura mater); Epidural hematoma (associated with skull fracture and injury); Intracranial hematoma (blood vessels within the brain are damaged) Second Impact Syndrome – second brain injury occurs before symptoms of primary injury have been resolved; can occur from something as minor as a hit to the chest or back and the related motion of the head Tx – prevention is only cure!! No participation in contact or collision athletics while symptomatic from any brain injuries.

Head Injuries Diagrams/Illustrations:

Mini-Quiz Time!!! 1. What are the two divisions of the head when discussing head injuries? 2. Why do the symptoms of hyphema lessen, after the first few days, even though the condition is not resolved? 3. What is the easiest way to prevent Swimmer’s Ear? 4. Why is there usually a secondary fracture with a jaw fracture, and where does it occur? 5. Why might you NOT want to put moderate pressure on a scalp laceration to control the bleeding?