Chapter 23 The Head and Face

Objectives Upon completion of this chapter, you should be able to: Describe the anatomy of the head and face Discuss common injuries to the head, face, teeth, eyes, nose, ears, and scalp Explain various injuries of the brain that a person might suffer as a result of athletic participation

Objectives (cont’d.) Upon completion of this chapter, you should be able to (cont’d.): Explain the signs and symptoms of a concussion Demonstrate on-field management and assessment of concussions

The Head and Face Face includes - eyes, ears, nose, jaw, mouth Cranium (skull) - contains brain and spinal cord attachments

The Eye Composed of: Sclera Extrinsic and intrinsic eye muscles Cornea Choroid coat, iris, pupil Lens and related structures Retina Optic disc and fovea

The Eye Protected by orbital socket of skull, and the eyebrows, eyelids, and eyelashes Lacrimal secretions (tears) cleanse and moisten on continuous basis Location of the eyes allows superimposition of images – enables us to see in 3D

Pathway of Vision Images in the light cornea pupil lens  where the light rays are bent or refracted  retina rods and cones pick up stimulus optic nerve optic chiasma optic tracts occipital lobe of brain for interpretation

Pathway of Vision Sclera- outer layer “white of the eye” Maintains shape and protects Muscles that move the eye attach here Cornea- “window of the eye” Transparent to permit passage of light rays Have pain and touch receptors Injury here can cause scarring and impaired vision

Pathway of Vision Choroid Coat and Iris Dark pigment of choroid coat prevents light reflection within eye Eye color related to # and size of melanin pigment in iris Intrinsic eye muscles within iris contract or dilate to control amount of light entering the pupil

Pathway of Vision Retina- light rays from an object form an image here Contains rods (dim light) and cones (bright light and color vision) Lens- disc shaped curvature alters with age Held in place behind pupil by suspensory ligaments Aqueous humor and vitreous humor help maintain spherical shape of eye, refracting light rays as they pass through

Animation - Vision Click Here to Play Vision Animation

Eye Injuries Most common in sports (basketball, baseball, and racquet sports) and in younger people Prevention- wearing athletic eyewear Eyeglasses do not protect and may put athlete at increased risk for injury

Eye Injuries Specks in the eyes- Can cause corneal abrasion Tx: splash clean water or solution to flush out; if object embedded in the eye, do not remove, cover eye with sterile pad Blows (contusions) to the eye Tx: cold compress; consult physician if internal damage suspected Cuts, Punctures, and abrasions of the eye or eyelid Do not wash or remove object; bandage to protect, seek medical care

Eye Injuries Orbital blow-out fracture- pain, swelling, double vision, numbness, protrusion of eye Tx: bandage both eyes, ice, see ophthalmologist immediately Hyphema- bleeding in anterior chamber Decreased vision See ophthalmologist; usually reabsorbs Conjunctivitis “pink eye”- viral, allergic, and bacterial Discomfort, redness, inflammation, pain, discharge Tx: Seek medical care Sty- infection of a gland along the eyelid

The Ear Outer ear - Visible part of ear - Tiny hairs trap dust, pollen, foreign objects Middle ear - Conducts sound to inner ear - Passes on the vibrations of sound from compression and decompression of outside air Inner ear - A maze of winding passageways (labyrinth) - Posture and directional info registered by relevant cells and conveyed by nerve fibers to the brain

Animation - Hearing Click Here to Play Hearing Animation

Injuries to the Ear Cauliflower ear Swimmer’s ear Deformity caused by outer ear cartilage damage - blood collects and thickens outer ear Tx: drain and immediate compression to prevent deformity Swimmer’s ear Infection of skin covering outer ear canal usually caused by excessive water exposure S/S: feels “full”, may itch, swell, drainage, pain, may swell shut Keep dry, wear earplug to keep water out

Injuries to the Ear Foreign bodies lodged in the ear S/S: pain, drainage, fever, nausea and vomiting, coughing, dizziness, foul odor from infection Tx: if don’t fall out naturally, gentle flushing with warm water; live insects killed before removal; surgery occasionally Tympani (eardrum) rupture Perforation of tympanic membrane S/S: pain until rupture occurs and relieves pressure; drainage

The Nose Composition of bone, cartilage, and skin Projects from frontal bone of cranium and maxillae of face Serves as an air passage between nostrils and throat, and sense of smell Warms, moistens, and filters air that enters nostrils and travels to lungs Can detect ~10,000 smells Highly vascular

Injuries to the Nose Epistaxis-Nosebleed Dryness or trauma, high blood pressure, cholesterol, aging, tumors, medication, leukemia, liver failure Sit, lean forward, squeeze soft portion, ice pack Nasal fractures and septal deviations Break in bone or damage to cartilaginous structures S/S: deformity, swelling, laceration, ecchymosis, epistaxis, cerebrospinal fluid (CSF) leakage Tx: control bleeding, refer Epistaxis—usually refers to the major, hard to stop or recurring nosebleeds. Posterior nose bleed- no blood from nostrils, complain of swallowing blood. No way to stop, should activate EMS Can wear facemask after fx

Injuries to the Nose

The Mouth and Jaw Mouth - Soft palate - Hard palate Mucous Membranes Tongue, lips, cheeks 32 teeth Jaw - Maxilla Attached to skull at Temporomandibular Joint - Mandible (TMJ)

Injuries to the Mouth and Jaw Soft-tissue injuries Cuts or lacerations to the lips, tongue, inside of the mouth, or face Dental injuries Fractured teeth, partially or totally knocked out, tooth-related structures (ie braces) Jaw-related or bone-related injuries Contusions, and alveolar fractures (houses teeth), jaw fractures

Injuries to the Mouth and Jaw Jaw Fractures Usually 2 fx sites – direct and indirect S/S: severe pain, swelling, blood at base of teeth, deformity, tenderness, numbness Tx: immobilization, ice, treat for shock, immediate physician referral Temporomandibular Joint- sprain, dislocation, sprain fx S/S: inability to close mouth, severe pain, deformity, swelling Tx: Ice, refer to physician Direct- at site of impact ; indirect- somewhere else along jaw, usually at condyles near TMJ joint Fx: may have to wear special helmet or mouth guard when return to play TMJ-allows mouth to open and close; result of direct trauma, malocclusion (teeth not coming together), muscle imbalance, postural imbalance Sprain fx: ligament pulls loose a fragment of bone

Injuries to the Mouth and Jaw

Injuries to the Mouth and Jaw Teeth S/S: loose, chipped, or missing teeth, pain in involved teeth and gums Tx: place back in socket and have them hold to keep it in place, refer to dentist immediately If can’t reinsert, wrap in sterile, moist gauze for them to take to dentist The longer the tooth is out of the mouth, less likely it can be saved Put tooth in milk, or “tooth-saver” liquid solution

The Head Cranium consists of: Frontal bone - strong Temporal bone - weaker Mastoid sinuses Occipital bone Foramen magnum- spinal cord passed through here Parietal bone Sutures- immovable joints that join all cranial bones - sinus- cavity within a bone

https://www.youtube.com/watch?v=8F9jXYOH2c0

The Head (cont’d.) The brain Brainstem- controls life sustaining functions (ie. breathing and heartbeat) Cerebellum- controls muscular coordination and complex actions (throwing, driving, balance) Cerebrum- higher thinking Divided into lobes which have specific functions Meninges- pad brain from impact Cerebrospinal fluid also protects, carries nutrients to and removes wastes from brain cells Temporal- hearing, memory ; Frontal- higher intellectual function, speech production, motor control Parietal- somatic sensory area ; Occipital- auditory comprehension, vision, visual perception

Head Injuries Approximately half U.S. trauma-related deaths are due to head injuries Head injuries include: Scalp injuries- Contusions and lacerations Bleeding, tenderness, swelling, hematoma (“goose egg”) Skull fractures- Uncommon but do occur Bleeding, CSF drainage from ear or nose Tx: immobilize, control bleeding, treat for shock, EMS

Brain Injuries Most serious threat to an athlete Usually result from movement of the brain within the skull Forceful impact causing temporary dysfunction (cerebral concussion) Transmission of force from skull to underlying tissue causing bruising or laceration (cerebral contusion) Contusion or lacerations Contrecoup Injury Contrecoup- brain rebounds off of other side of skull after impact

Brain Injuries (cont’d.) Concussion- mild traumatic brain injury More than 300,000 sports related occur annually Take history, palpation, neurological screening S/S: confusion, amnesia, LOC, headache, dizzy, poor coordination, distracted, etc. Tx: should not return to current game or more until cleared, monitor, must follow RTP Prevention: protective equipment, rule enforcement by referees, keep head up when tackling, education **state law/UIL guidelines/NATA position statement hw assignment

Brain Injuries (cont’d.) Look up these concussion tools---what they are, how they are used, who uses them, etc: ImPACT, King-Devick, SCAT3, Glasgow Coma Scale, Alert/Verbal/Painful/Unresponsive (AVPU)

Brain Injuries (cont’d.) Amnesia Retrograde or antegrade Postconcussion syndrome Follows a concussion Persistent headache, dizziness, fatigue, irritability, impaired memory, lack of concentration May persist for days or weeks indicating alternate brain functioning -Retrograde- loss of memory for events before injury; antegrade- after injury

Brain Injuries (cont’d.) Brain contusions Result when the brain collides against the skull or is raked over bony irregularities Hemorrhage Can lead to rapid deterioration Subdural, epidural, and intracranial hematoma Tx: MUST continue to monitor after head injury subdural- blood between surface of brain and dura mater --may progress rapidly or take hours to days Epidural- blood between skull and dura mater -- clot formation usually rapid and S/S occur in minutes to hours Intracranial- pooling of blood from damage within brain -- may occur when cerebral contusion accompanied by significant bleeding

Brain Injuries (cont’d.)

Brain Injuries (cont’d.) Secondary impact syndrome Second head injury occurs before symptoms of a previous injury have been resolved Rapid swelling and herniation Prevention is the only cure – very important that athlete with symptoms from head injury does not continue in sport - Can occur without impact to the head; can occur with blow to chest or back that causes head/brain movement

Animation – Head Injuries Click Here to Play Head Injuries Animation

Head Injuries Second Impact Syndrome https://www.youtube.com/watch?v=Ai5AXF7XKw8

Conclusion Injuries to the head and neck can be serious and life threatening Proper care and management can be the difference between full or partial recovery A complete understanding of head and brain anatomy, as well as the mechanism of injury, will give the proper tools for accurate assessment