The Face Lecture 19

Facial Injuries Injuries to the cheek, nose, lips and jaw are very common in sports - especially those with moving objects, and or contact sports. Wearing proper protective equipment can prevent many injuries. Because the face has a vast arterial system, lacerations bleed freely and rapid swelling often occurs.

Soft Tissue Injuries contusions, abrasions, lacerations are all managed the same on the face as in the rest of the body. Minor lacerations ( less than 1 inch long and 1/8th inch deep) can be closed with a steristrip other wise sutures should be done.

Facial Fractures Direct impact can fracture facial bones including the mandible (the jaw), maxilla (upper jaw) zygomatic (cheek) or the nasal bones

Nasal Fractures- most common facial fracture in sport, it is particularly susceptible to lateral displacement. Nose may appear flattened and lose its symmetry. Deformity is usually present- especially with a lateral blow Nosebleeds are almost always seen.

There may be crepitus over the nasal bridge and ecchymosis under the eyes Rx- Control the bleeding, apply ie. to limit swelling and refer to Physician

Zygomatic Fractures With direct impact to the zygomatic bone the cheek will appear flat or depressed Swelling and ecchymosis about the eye may interfere with vision Rx- Refer to doctor ASAP

Mandibular fractures are the third most common fracture associated with sports participation behind the nasal and zygotic fractures. Seldom occur as isolated fractures - but usually as double fractures or fracture - dislocation. In all fractures it is important to maintain an open airway, dress wounds, immobilize as best as possible and refer to physician.

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Nasal Injuries Epistaxis - nose bleed - in most cases bleeding will stop spontaneously by applying mild pressure at the nasal bone, ice may be used to stop persistent bleeding, Nasal plugs may be used - if bleeding continues for more than five minutes refer to physician.

Oral and Dental Injuries To prevent dental injuries - mouthgaurds should be used at all times Lacerations of the mouth - RX- Apply direct pressure - cleanse the area with a saline solution Lacerations that extend completely through the lip or large tongue lacerations - require special suturing

Dental Injuries - when the tooth is displaced outwardly or laterally - try to place tooth back into its normal position when a tooth is displaced inwardly - it should be left alone all dental injuries should be seen by a dentist ASAP Teeth that have been totally avulsed from their socket can often be located These teeth can be saved but time is of the essence

Do not touch the root or brush the tooth off If the tooth is rinsed in milk or saline and replace intraorally with 30 minutes the prognosis for successful replanting is 90% Replanting that occurs after 2 hours results in a 95% failure rate The tooth can be replace or place under the tongue for transport to the dentist Tap water or drinking water will damage the root and compromise replanting, hense should not be used

Fractures - should be referred to dentist ASAP

Ear Injuries Cauliflower ear- a relatively minor injury caused by repeated trauma - a hematoma forms between the perichondrium and the cartilage of the outer ear

The hematoma should be aspirated by a physician to avoid permanent cartilage damage If left untreated the hematoma forms a fibrosis in the overlying skin, leading to necrosis of the auricular cartilage, resulting in the cauliflower ear appearance Protective headgear in sports such as boxing, wrestling, water polo and rugby is designed to prevent trauma to the ear but must be worn regularly to be effective Rx - PIER

Eye Injuries Many eye injuries can be prevented with proper protective wear Especially true in racquet sports (squash, racquetball) Periorbitaal Ecchymosis ( Black Eye) - swelling and hemorrhage into the surrounding eyelids and area Inspect eye for obvious abnormalities and palpate for possible orbital fractures

Inspect the anterior chamber of the eye for bleeding Check the ability of individual to focus Ice the eye by using crushed ice or ice water in a latex surgical glove, do not use chemical bags Rx- Refer to ophthalmologist for further examination

Foreign bodies- dust or dirt can lead to intense pain and tearing The foreign body if not imbedded should be removed The eye should be inspected for any scratches, abrasions or lacerations If unable to remove -patch both eyes with a sterile gauze pad and refer to physician

Conjunctivitis ( Pinkeye) A bacterial infection of the conductive (the membrane between the inner lining of the eye lid and the anterior eyeball) The infection leads to itching, burning and watering of the eye, causing the conjunctiva to become inflamed and red - giving it a pinky appearance Rx- This condition is highly infectious - refer to physician

Corneal Abrasion - a foreign body may scratch the cornea - resulting in pain and tearing Blinking and movement aggravates this condition A corneal abrasion is best seen by using a fluorescein dye strip - the dye alluminates the abrasion Rx- involves an topical ointment and an eye patch

Detached Retina - damage to the posterior segment of the eye can occur with or without trauma to the anterior segment A detached retina occurs when fluid seeps into the retina; break and separates the neurosensory retina from the retinal epithelium This can occur days or weeks after the initial trauma

Condition is often described as a curtain falling over their eye - or seeing flashes of light going on and off Rx - Immediate referral to ophthalmologist