1. Facial Injuries in Sports and Exercise

3. Epidemiology Scope of the problem 18% of all athletic injuries Boys: 3 times more facial injuries than girls Most frequently associated sport: –Before 1964, Football –Now Baseball (40%)

4. 50 : 50 –50% mouth & teeth –50% ears, nose & face Low Speed –elbows & fists –soft tissue lacerations & contusions High Speed –balls, pucks, sticks –Bone / tooth fractures Epidemiology: Oral and Facial Trauma

5. On Field Assessment ABC’s always come FIRST –Airway –Breathing –Circulation –Don’t get distracted! C-spine precautions

6. On Field Assessment History –How? (MOI) –Other Injuries? Other symptoms Respiratory symptoms? –Concussion? Symptoms –Leakage of fluid (LOF)? –Able to move jaw? –Teeth mesh normally?

7. Facial Fractures

8. Mandible and Maxilla fractures –Look for teeth allignment –May require wiring of the teeth

9. Common Injuries Nasal Injuries Ear Injuries Mouth Injuries Teeth Injuries Eye Injuries

10. Nasal Injuries Most commonly injured structure of the face –Fractures –Septal deviation –Epistaxis –Septal hematoma Saddle deformity

11. Septal Hematoma Collection of blood b/w cartilage septum & muco- perichondrium Most often associated with fracture Dx: grape-like, blue bulge that obstructs nares Left untreated: can cause “saddle nose” deformity

12. Nasal Injuries

13. Common Injuries Nasal Injuries Ear Injuries Mouth Injuries Teeth Injuries Eye Injuries

14. Ear Problems

15. Auricular Hematoma (“Wrestler’s Ear”)

16. Auricular Hematoma Trauma causes bleeding between skin and cartilage Untreated  –Pressure necrosis –Fibroneocartilage formation –Unsightly scarring Tx: prompt drainage

17. Auricular Hematoma Needle Drainage Need to be promptly aspirated –Have done up to 10 days out Sterile conditions +/- Prophylactic antibiotics

18. Auricular Hematoma Clot Evacuation After evacuation, apply compression for 7-10 days to prevent hematoma recurrence

19. Auricular hematoma Unreliable techniques for compression:

20. Best technique for compression: Sutured tubular gauze Allows quick return to play Need to protect it! Auricular Hematoma

21. Y O U M A K E T H E C A L L OR

22. Auricular Laceration Key is to look for cartilage involvement Anesthesia: no epi Repair cartilage first w/ 5/6-0 suture Then repair skin Tetanus +/- oral abx

23. Tympanic Membrane Rupture “The Eardrum” Mechanism of injury –Percussive blow or slap to side of head Explosions Travel at altitude Diving Boxing, wrestling, martial arts Water skiing Surfing Wake Boarding

24. Tympanic Membrane Rupture Symptoms –Painful “pop” –Minor bleeding –Unilateral hearing loss –Can have vertigo &/or nausea –Usually no treatment needed

25. Otitis Externa “Swimmer’s Ear” Infection of external auditory canal Swimmers Other water sports Pain with auricle movement Red, swollen EAC +/- exudate

26. Otitis Externa Prevention ? Cotton w/ petroleum jelly during swimming

27. Nasal Injuries Ear Injuries Mouth Injuries Teeth Injuries Eye Injuries

28. Lip Lacerations Mucosa-only lacs heal well w/o sutures Deep or thru & thru lacerations require layered repair Vermilion border: approximate border FIRST, then repair remainder (consider referral) Prophylactic abx or chlorhexidine rinse bid

29. Tongue lacerations Irrigate, remove foreign bodies Repair muscle with 3-0 absorbable if deeper than 5mm Repair mucosa if still necessary, absorbable is fine

30. Common Injuries Nasal Injuries Ear Injuries Mouth Injuries Teeth Injuries Eye Injuries

31. Tooth Fracture Enamel Fracture –Small chips in enamel –Uniform color at fracture site –Dentist referral to smooth rough enamel edges prn –Continue playing!

32. Tooth Avulsion (“knocked out”) Pick up tooth by ENAMEL only, not roots Re-implant w/in 30 min = 90% success After 6 hrs, <5% If can’t replace, transport in Save-A- Tooth solution > milk > saline buccal pouch Prophylactic antibiotics & Tetanus booster Dentist referral ASAP Aspirated teeth need to be removed by bronchoscopy

33. Teeth Injuries Mouthguards –effectively prevent most sports related dental injuries –Encourage athletes to wear mouthpieces!

34. Common Injuries Nasal Injuries Ear Injuries Mouth Injuries Teeth Injuries Eye Injuries

35. Eye Injury Gallery

36. Corneal Abrasion - Topical or oral analgesics - Exam every 24 hours until healed -refer if taking >72 hrs - NOT RECOMMENDED: patch, midriatics -Unknown effectiveness: abx Eye Injury Gallery

37. Retinal Detachment - Optho referral Eye Injury Gallery

38. Superficial –Apply topical analgesic –Remove object w/ needle tip Deeper: REFER Superficial –Apply topical analgesic –Remove object w/ needle tip Deeper: REFER

39. Subconjunctival Hemorrhage - Most resolve in 2-3 wks - More extensive ( ~ 360°)  optho referral Hyphema - Optho referral -Bedrest Eye Injury Gallery

40. Eyelid Laceration “Run, Luke. Run!” Eyelid Laceration After Appropriate Referral Eye Injury Gallery

41. Questions?