HEAD AND FACE CHAPTER 22

ANATOMY

SCALP Scalp Skin Connective Tissue Apeneurosis Loose Connective Tissue Periosteum

CRANIUM Encases the brain Bones of the head Parietal (2) Temporal (2) Occipital (1) Sphenoid (1) Frontal (1) Ethmoid (1)

CRANIUM Bones of the face Mandible - jaw Nasal (2) Zygomatic (2) Maxilla (2) Mandible - jaw

MENINGES Between the skull and brain Covers the brain and spinal cord Three layers Dura mater – thick, dense, inelastic layer Epidural space – between skull and dura mater Arachnoid – looks like spider web, delicate Pia mater – thin, transparent, follows brain contour

Cerebrospinal Fluid Find it in Subarachnoid space Between arachnoid and the pia mater Function is to cushion the brain

BRAIN Cerebrum Cerebellum Coordinates voluntary muscle activity Senses Higher mental functions Memory, reasoning, learning, judgement, emotions Cerebellum Muscle movements Balance

BRAIN Pons Medulla Oblongata Sleep Posture Breathing Swallowing Bladder Medulla Oblongata Heart rate Blood pressure Coughing and sneezing Vomiting

HEAD INJURIES

Head Injuries FYI: Damage done is not always proportional to the blow to the head Same blow to two different people will can cause two dramatically different injuries

Signs of a Worsening Head Injury Decreased level of consciousness More confused or irritable Persistent or increasing headache Decreased pulse Increased blood pressure Pupil irregularity Weakness in extremities Nausea, vomiting Anything you can say is not characteristic of person

Skull Fracture MOI: VERY hard blow (ie, shot put, hammer, baseball bat) Can be obvious (depressed) or subtle (crack) fracture Signs and symptoms Rhinorrea: Discharge from nose – can be blood or cerebrospinal fluid Otorrea: Discharge from ears – can be blood or cerebrospinal fluid

Epidural Hematoma Epidural: Between the skull and the dura mater Hematoma: collection of blood Cause: hit to the head Symptoms come about rapidly They have a “Lucid Interval”: May show signs of getting better and then becomes unconscious Will need surgery to relieve pressure in brain

Subdural Hematoma Subdural: below the dura mater, b/n the dura mater and the arachnoid Cause: hit to the head Slower onset Acute: most common cause of death with head injury in athletics (ie, boxing) Chronic: can take days or weeks for symptoms to manifest Small amount of blood, and a membrane develops around it and it increases in size over time Also surgically relieved

Concussion A traumatically induced alteration in mental status not necessarily with a loss of consciousness Can happen from a directly or indirectly Directly: hit to the head Indirectly: hit to the body or whiplash Any athlete who shows signs or symptoms of a concussion must be removed from play!

Concussion Signs and Symptoms Headache Dizziness Nausea Loss of consciousness Amnesia (memory loss) Inability to concentrate Vision problems Ringing in ears Emotional instability Fatigue

CONCUSSION Care REST – No activity – physical or mental Refer to doctor YOU SHOULD NEVER, NEVER PARTICIPATE IN ANY PHYSICAL ACTIVITY WHILE YOU HAVE SYMPTOMS OF A CONCUSSION!

SECOND IMPACT SYNDROME Rapid swelling of the brain that occurs when someone sustains a second head injury before the previous head injury has resolved. This can be a very minor injury (2nd one) that causes major problems. This typically is fatal. Athlete must be rushed to hospital IMMEDIATELY.

FACIAL INJURIES

Mandibular (Jaw) Fractures Cause: Direct blow, will usually fracture at the angle S/S Will be unable to fully open and close mouth Malocclusion: unable to bring teeth together Possible bleeding at base of teeth May have numbness in low lip May have multiple fractures Care: Immobilize, jaw wired shut for 4-6 weeks

Nasal Fracture Cause: Direct blow May or may not be displaced Care Control bleeding – do not put anything up nose Ice Refer to MD

Epitaxis (Nose bleed) Cause: can be many things Hit to the nose Dry air Control by sitting upright, head forward, gauze at nostrils and apply pressure at bridge of nose Do not remove gauze if bloody, just apply fresh gauze around it

Cauliflower Ear Skin in upper ear separates from cartilage and it fills with blood Wrestling – ear sticks to mat Will harden if left untreated – permanent deformity MD can drain it if caught early on

SWIMMER’S EAR (Otitis Externa) Infection of the ear canal S/S Ear pain Dizziness Ear itches Discharge from ear Care Refer to MD, rule out ear drum rupture Antibiotics

Corneal Abrasion Cause: Poked in the eye Will feel like something is in the eye Eye may tear up Can be painful, may not want to open eye If no relief from eyewash, see MD

Periorbital Hematoma Black Eye – no big deal, right? Eye symptoms to worry about Blurred and/or double vision Spotty vision Pain Blood in the eye

Blow Out Fracture Fracture of the orbit of the eye Cause: Direct hit to the eye Usually it is the floor of the eye that fractures Limits movement – cannot look up May have double vision (diplopia) Immediate referral to MD

Tooth displacement and avulsion Cause: direct hit to mouth If found keep the tooth If it is still in place somewhat, leave it there Otherwise, in sterile saline or milk Immediate referral to dentist – two hour window for re-implantation