Facial Injuries Soft Tissue Injury –Abrasions, Contusions, Lacerations, Avulsions Lots of bleeding - Why? Clean and cover - Why? –Epistaxis - Nosebleed DON’T BLOW NOSE - REMOVES CLOT Bony Injury –Nasal Bone Fracture - most common –Nasal Septum Fracture - Cartilage and bone More serious - hematoma may develop Tx: Ice, nose packing, refer

Facial Injuries Bony Injuries - MOI: direct blows –Mandible(Jaw) Fracture - 2nd most common Malocclusion of teeth, bleeding around teeth, lower lip numbness Ice, immobilize, Dr. –Mandible Dislocation - TMJ joint Locked open, extreme malocclusion DON’T REDUCE, ice, immobilize, Dr. –Zygomatic Fracture - 3rd most common Deformity, epistaxis, vision problems(diplopia) –Maxillary Fracture - 4th most common Malocclusion, deformity, vision problems, epistaxis LeFort Fractures

Eye Anatomy Anatomy –sit in orbit(bony) protection –eyelid –lacrimal glands –sclera - tough white outer layer –cornea, iris, lens –pupil

Eye injuries Injuries Can be very serious, must be evaluated and referred to opthamologist if necessary. Orbital Hematoma (black eye) Foreign Body Pain and disability, tearing DON’T RUB IT OUT - Why? Corneal Abrasion Pain, tears, blurred vision Patch, Dr., Flourescein Strips (Blue light) 1-2 days to heal

Corneal abrasion

Iritis Conjunctivitis Traumatic iritis/Chronic iritis Inflammed conjunctiva next to cornea over iris, photophobia, slow reaction Conjunctivitis Viral (“pink eye”) or bacterial (yellow/green) Itchy, burning, reddening, discharge, eyelid swelling, blurry, sticky eyes Stye – DO NOT SQUEEZE bacterial infection that occurs inside an oil gland near the base of your eyelid. Stye

Eye Injuries Hyphema –Blood in eye, vision block(full or partial) –Patch both eyes, NO ICE, Medical emergency Blowout Fracture - orbit of eye is fractured –Hit on orbit, hit on eye(inc. pressure=blowout) –Discoloration inferior margins, Inability to move eye up, diplopia (double vision), pain Retinal Detachment –Direct blow –Specks in vision, “flashes of light”, “curtain falling over vision” Acute Trauma –Be aware of lacrimal gland lacerations and damage to other structures

Pencil was in eye “tear drop” iris Blow out fracture

Dental Injuries Anatomy Crown Dentin Pulp Root Enamel Injuries –Teeth have lowest potential to return to a state of health following traumatic injury. –Role to athletic trainer - care for athlete and tooth and get athlete to dentist if necessary. Do not touch root or tooth

SAVE A TOOTH SAVE A TOOTH - balanced solution - Transport Media OR Milk, Saline, Saliva, Water

Dental Injuries Tooth Displacement –Extrusion or Lateral Luxation Can try to reposition, Dentist –Intrusion Don’t try to reposition, mouth closed, Dentist Fractured Tooth - crown or root –No return, Dentist, save tooth fragment Tooth Avulsion –Handle tooth by crown only –Replace in socket if possible –Save tooth - keep moist at all times –Dentist - 1/2-2 hrs. less than 30 mins. = 90% survival rate greater than 2 hrs. = 5 % survival rate

Ear Injuries Anatomy –External Ear, Middle Ear, Internal Ear Injuries –Swimmer’s Ear - External Otitis –Ear Infection – Otitis Medius –Hematoma Auris MOI: extreme friction S/S: swelling, hematoma Tx: ice, compression, aspiration, collodian pack –Cauliflower Ear Hardened tissue of untreated hematoma auris Keloid tissue is resultant

Prevention of Facial, Dental, Ear, and Eye Injuries Protective Equipment –Helmets –Facemasks –Eye Protection –Mouthguard –Ear Protection

History What is the major complaint? What is mechanism of injury? What is its duration? Was the onset of the complaint gradual or sudden? Is there any loss of vision, hearing, taste, smell? Can they swallow and speak without difficulty? Is there any pain? Is the condition improving or getting worse? Is there any history of trauma? Is there any family history of a similar complaint?

Observation Inspect all facial areas –Be aware of alignment, bleeding, ecchymosis (ruptured blood vessels)

Removing a foreign object

Inspection/Palpation Orbital margin Frontal bone, Nasal bone, Zygomatic arch, Maxilla, Mandible Temporomandibular joint (TMJ) Teeth Soft tissue – Nasal, Cheeks, Ear

Functional or Special Tests Vision Assessment –Snellen Chart Myopia – nearsightedness Hyperopia – farsightedness –Visual acuity – photophobia or diplopia –Anisocoria – condition of unequal pupils Pupil Reaction to Light –Pen light –PEARL – pupils equal and reactive to light Eye Motility –“follow my finger but do not move your head” –Nystagmus Flourescein dye test (if available)

Functional or Special Tests Hearing and Balance Smell Jaw motion and Teeth alignment –Malocclusion (misalignment) –Open, Close, Side to Side, Protract –Palpation at TMJ – pinkies in ear Dermatomes –Sensation

When should I refer? Visual field changes –Photophobia (light sensitivity) and/or Diplopia (double vision) –Cloudy vision –Nystagmus Pain/Throbbing intense Crepitus or Laceration Deformity – bony or tooth S/S of serious injury Numbness Hearing or Balance issues Oozing pus or drainage of water