Rehab Head & Face Ch 23 3 The nose, mouth, jaw and brain Kelly Hutchison

 Outer nose composed of bone, cartilage, and skin, and projects from the front of face, making it susceptible to injury.  Serves as air passage for respiratory system and Provides brain with the sense of smell. Nose

 Nose bleed  Posterior Epistaxis athlete c/o swallowing blood; can be life threatening  Anterior Epistaxis TX: Sit down, lean forward, and squeeze soft portion of the nose for approx. 5 minutes and repeat if necessary. Apply cold compress helps thicken blood and slows down bleeding.  Epistaxis

 Cause: direct blows or falls  Nasal bones are the most commonly fractured bony structures of the face.  S/S: deformity, swelling, skin laceration, ecchymosis, epistasis, and leakage of CSF (Cerebral spinal fluid).  TX: Careful direct pressure, application of ice, have athlete sit slightly forward. Should see physician. Nasal Fractures and Septal Deviations

 Mouth includes soft and hard palate, mucous membranes, tongue, teeth, lips, and cheeks.  Soft palate-the back portion of the roof of mouth  Hard palate-the front portion of the roof of the mouth  Maxilla- bone in upper jaw; fixed to the skull  Mandible- bone in the lower jaw which is attached by a movable joint called the (TMJ) temporomandibular joint. Mouth and Jaw

 Usually includes 2 fractures (1 Direct and 1 Indirect)  The indirect fracture is usually located near one of the condyles of the mandible close to the joint.  S/S Sever pain, swelling, blood at the base of teeth near fracture, deformity, tenderness, and sometimes numbness.  Treatment: immobilization, application of ice, treatment for shock. Transport athlete to physician. Jaw Fracture

 Change the function of most of the mouth parts since they all work together to open and close the mouth.  S/S: Malocclusion (teeth not coming together), muscle imbalance, postural imbalance, severe pain, deformity, swelling, popping and difficulty opening/ closing mouth.  TX: ICE and referral to physician Temporomandibular Joint Injuries

 Mouth guards help prevent tooth injuries.  S/S: loose, chipped, or missing teeth and pain  TX: Putting tooth back in socket and transport to dentist. If not able to place back in socket place tooth in milk or coconut water and transport to dentist. Longer tooth is out the less likely it can be saved. Teeth

 Cranium is a collection of bones fused together to protect the brain.  Frontal bone-forehead  Temporal bone- sides and base of skull  Mastoid sinuses- air filled spaces within the mastoid process of temporal bone behind ears.  Occipital bone- posterior bone of the skull  The spinal cord passes through the occipital bone through the foramen magnum.  Parietal bone- largest bones of skull  Sutures –immovable joints, composed of connective tissue, where cranial bones meet; fused together. Head

 Brainstem- controls life sustaining functions, heart beat and breathing.  Cerebellum- controls muscular coordination and complex actions.  Cerebrum- largest and highly evolved part of the brain. Divided into a left and right hemisphere and is the center for all complex activities and sensory reception.  Meninges – 3 membranes covering brain a spinal cord.  Pia matter- inner most layer covering brain and spinal cord  Arachnoid- web like middle protective layer cover brain and spinal cord.  Dura mater- the outermost layer membrane covering brain and spinal cord. Brain

 May or may not involve the skull or brain  Common are scalp lacerations or contusions  S/S: include local tenderness, swelling, bleeding between the skin and underlying tissue.  TX: Locate source of bleeding, control by direct pressure.  If you suspect depressed skull fracture do not apply pressure. Scalp injuries

 Range from a simple linear fracture to severe compund fracture depressed fracture, with bone fragments lacerating brain tissue.  S/S: including bleeding or cerebrospinal fluid drainage from the ear or nose.  TX: Activate EMS (911) and treat for shock. Skull Fractures

 Cerebral Contusions- bruising or laceration of the brain tissue from the impact of the skull on underlying tissue.  Cerebral Concussion- injury to the brain from a forceful impact causing temporary dysfunction.  Both Cerebral Contusions and Cerebral Concussion can result in Countercoup.  Countercoup- mechanism of injury in which the brain rebounds off the other side of the skull after the initial impact.  Concussions are more common with sports injuries. Brain Injuries

 S/S: can include being unaware of surroundings, date, time, or place; loss of consciousness; confusion, amnesia, headache, dizziness, nausea, unsteadiness/ loss of balance; ringing in the ears, double vision or seeing flashes of light; sleep disturbances; convulsions; exhibiting inappropriate emotions; vacant stare; slurred speech. Concussion

 A standard guide to rate state of consciousness Glasgow Coma Scale (GCS)

AVPU –method of determining consciounesss

 Review history of injury  Inspection, palpation of cervical vertebrae and musculature, and neurological screening of sensory and motor function and pupil size.  Raised intracranial pressure and temporal lobe herniation will cause compression of the oculomotor nerve. Resulting in pupil dilation.  Pupil dilation- widening of the pupils due to increased intracranial pressure compressing the third intracranial nerve.  Removal from game or practice monitoring for deteroriation, medical evaluation. A medically supervised, stepwise process to determine return to play status. Concussion TX

 Amnesia-  Retrograde Amnesia- loss of memory for evens that occurred before the injury.  Antegrade Amnesia- loss of memory occurring immediately after awakening from loss of consciousness.  Post concussion Syndrome- a condition that may develop following a concussion; exhibited by persistent headache, dizziness, fatigue, irritability, and impaired memory of lack of concentration. Concussion Continued……

 May result in the lack of nerve function of the bruised portion, but usually will not result in a loss of consciousness.  S/S: numbness, weakness, loss of memory, aphasia (loss of speech or comprehension), or general misbehavior. Brain Contusions or Bruising

 Subdural- collection of blood between the surface of brain and dura matter. Develops when bridging cerebral vessels that travel from brain to dura matter are torn. Most frequent cause of death from trauma in athletics.  Epidural- develops when a dural artery is ruptured; it is often associated with a skull fracture. Collection of blood between the skull and dura mater.  Intracranial – develops when the blood vessels within the brain are damaged.  All hematomas can cause an increase in intracranial pressure that can result in death or disability if not dealt with appropriately. Hemorrhage or Bleeding Potentially Life Threatening

 Rapid swelling and herniation of the brain after a second head injury occurs before the first injury has resolved.  The second injury may not even be a direct blow directly to the head, but rather nearby area, such as the chest or back, that causes the head to react to the blow.  Prevention is the only cure. Athletes must not be allowed to participate in contact or collision activities until all cerebral symptoms have resolved. Secondary Impact Syndrome (SIS)