2. Chapter 23
The Head and Face

3. Objectives Upon completion of this chapter, you should be able to:
Describe the anatomy of the head and face
Discuss common injuries to the head, face, teeth, eyes, nose, ears, and scalp
Explain various injuries of the brain that a person might suffer as a result of athletic participation

4. Objectives (cont’d.)
Upon completion of this chapter, you should be able to (cont’d.):
Explain the signs and symptoms of a concussion
Demonstrate on-field management and assessment of concussions

5. The Head and Face Face includes - eyes, ears, nose, jaw, mouth
Cranium (skull)
- contains brain and spinal cord attachments

6. The Eye Composed of: Sclera Extrinsic and intrinsic eye muscles Cornea
Choroid coat, iris, pupil
Lens and related structures
Retina
Optic disc and fovea

8. The Eye
Protected by orbital socket of skull, and the eyebrows, eyelids, and eyelashes
Lacrimal secretions (tears) cleanse and moisten on continuous basis
Location of the eyes allows superimposition of images – enables us to see in 3D

9. Pathway of Vision
Images in the light cornea pupil lens  where the light rays are bent or refracted  retina rods and cones pick up stimulus optic nerve optic chiasma optic tracts occipital lobe of brain for interpretation

11. Pathway of Vision Sclera- outer layer “white of the eye”
Maintains shape and protects
Muscles that move the eye attach here
Cornea- “window of the eye”
Transparent to permit passage of light rays
Have pain and touch receptors
Injury here can cause scarring and impaired vision

12. Pathway of Vision Choroid Coat and Iris
Dark pigment of choroid coat prevents light reflection within eye
Eye color related to # and size of melanin pigment in iris
Intrinsic eye muscles within iris contract or dilate to control amount of light entering the pupil

13. Pathway of Vision Retina- light rays from an object form an image here
Contains rods (dim light) and cones (bright light and color vision)
Lens- disc shaped curvature alters with age
Held in place behind pupil by suspensory ligaments
Aqueous humor and vitreous humor help maintain spherical shape of eye, refracting light rays as they pass through

14. Animation - Vision
Click Here to Play Vision Animation

15. Eye Injuries
Most common in sports (basketball, baseball, and racquet sports) and in younger people
Prevention- wearing athletic eyewear
Eyeglasses do not protect and may put athlete at increased risk for injury

16. Eye Injuries Specks in the eyes- Can cause corneal abrasion
Tx: splash clean water or solution to flush out; if object embedded in the eye, do not remove, cover eye with sterile pad
Blows (contusions) to the eye
Tx: cold compress; consult physician if internal damage suspected
Cuts, Punctures, and abrasions of the eye or eyelid
Do not wash or remove object; bandage to protect, seek medical care

17. Eye Injuries
Orbital blow-out fracture- pain, swelling, double vision, numbness, protrusion of eye
Tx: bandage both eyes, ice, see ophthalmologist immediately
Hyphema- bleeding in anterior chamber
Decreased vision
See ophthalmologist; usually reabsorbs
Conjunctivitis “pink eye”- viral, allergic, and bacterial
Discomfort, redness, inflammation, pain, discharge
Tx: Seek medical care
Sty- infection of a gland along the eyelid

18. The Ear Outer ear - Visible part of ear
- Tiny hairs trap dust, pollen, foreign objects
Middle ear
- Conducts sound to inner ear
- Passes on the vibrations of sound from compression and decompression of outside air
Inner ear
- A maze of winding passageways (labyrinth)
- Posture and directional info registered by relevant cells and conveyed by nerve fibers to the brain

20. Animation - Hearing
Click Here to Play Hearing Animation

21. Injuries to the Ear Cauliflower ear Swimmer’s ear
Deformity caused by outer ear cartilage damage - blood collects and thickens outer ear
Tx: drain and immediate compression to prevent deformity
Swimmer’s ear
Infection of skin covering outer ear canal usually caused by excessive water exposure
S/S: feels “full”, may itch, swell, drainage, pain, may swell shut
Keep dry, wear earplug to keep water out

22. Injuries to the Ear Foreign bodies lodged in the ear
S/S: pain, drainage, fever, nausea and vomiting, coughing, dizziness, foul odor from infection
Tx: if don’t fall out naturally, gentle flushing with warm water; live insects killed before removal; surgery occasionally
Tympani (eardrum) rupture
Perforation of tympanic membrane
S/S: pain until rupture occurs and relieves pressure; drainage

23. The Nose Composition of bone, cartilage, and skin
Projects from frontal bone of cranium and maxillae of face
Serves as an air passage between nostrils and throat, and sense of smell
Warms, moistens, and filters air that enters nostrils and travels to lungs
Can detect ~10,000 smells
Highly vascular

25. Injuries to the Nose Epistaxis-Nosebleed
Dryness or trauma, high blood pressure, cholesterol, aging, tumors, medication, leukemia, liver failure
Sit, lean forward, squeeze soft portion, ice pack
Nasal fractures and septal deviations
Break in bone or damage to cartilaginous structures
S/S: deformity, swelling, laceration, ecchymosis, epistaxis, cerebrospinal fluid (CSF) leakage
Tx: control bleeding, refer
Epistaxis—usually refers to the major, hard to stop or recurring nosebleeds.
Posterior nose bleed- no blood from nostrils, complain of swallowing blood. No way to stop, should activate EMS
Can wear facemask after fx

26. Injuries to the Nose

27. The Mouth and Jaw Mouth - Soft palate - Hard palate Mucous Membranes
Tongue, lips, cheeks
32 teeth
Jaw
- Maxilla Attached to skull at Temporomandibular Joint
- Mandible (TMJ)

29. Injuries to the Mouth and Jaw
Soft-tissue injuries
Cuts or lacerations to the lips, tongue, inside of the mouth, or face
Dental injuries
Fractured teeth, partially or totally knocked out, tooth-related structures (ie braces)
Jaw-related or bone-related injuries
Contusions, and alveolar fractures (houses teeth), jaw fractures

30. Injuries to the Mouth and Jaw
Jaw Fractures
Usually 2 fx sites – direct and indirect
S/S: severe pain, swelling, blood at base of teeth, deformity, tenderness, numbness
Tx: immobilization, ice, treat for shock, immediate physician referral
Temporomandibular Joint- sprain, dislocation, sprain fx
S/S: inability to close mouth, severe pain, deformity, swelling
Tx: Ice, refer to physician
Direct- at site of impact ; indirect- somewhere else along jaw, usually at condyles near TMJ joint
Fx: may have to wear special helmet or mouth guard when return to play
TMJ-allows mouth to open and close; result of direct trauma, malocclusion (teeth not coming together), muscle imbalance, postural imbalance
Sprain fx: ligament pulls loose a fragment of bone

31. Injuries to the Mouth and Jaw

32. Injuries to the Mouth and Jaw
Teeth
S/S: loose, chipped, or missing teeth, pain in involved teeth and gums
Tx: place back in socket and have them hold to keep it in place, refer to dentist immediately
If can’t reinsert, wrap in sterile, moist gauze for them to take to dentist
The longer the tooth is out of the mouth, less likely it can be saved
Put tooth in milk, or “tooth-saver” liquid solution

33. The Head Cranium consists of: Frontal bone - strong
Temporal bone - weaker
Mastoid sinuses
Occipital bone
Foramen magnum- spinal cord passed through here
Parietal bone
Sutures- immovable joints that join all cranial bones
- sinus- cavity within a bone

37. The Head (cont’d.) The brain
Brainstem- controls life sustaining functions (ie. breathing and heartbeat)
Cerebellum- controls muscular coordination and complex actions (throwing, driving, balance)
Cerebrum- higher thinking
Divided into lobes which have specific functions
Meninges- pad brain from impact
Cerebrospinal fluid also protects, carries nutrients to and removes wastes from brain cells
Temporal- hearing, memory ; Frontal- higher intellectual function, speech production, motor control
Parietal- somatic sensory area ; Occipital- auditory comprehension, vision, visual perception

39. Head Injuries
Approximately half U.S. trauma-related deaths are due to head injuries
Head injuries include:
Scalp injuries- Contusions and lacerations
Bleeding, tenderness, swelling, hematoma (“goose egg”)
Skull fractures- Uncommon but do occur
Bleeding, CSF drainage from ear or nose
Tx: immobilize, control bleeding, treat for shock, EMS

40. Brain Injuries Most serious threat to an athlete
Usually result from movement of the brain within the skull
Forceful impact causing temporary dysfunction (cerebral concussion)
Transmission of force from skull to underlying tissue causing bruising or laceration (cerebral contusion)
Contusion or lacerations
Contrecoup Injury
Contrecoup- brain rebounds off of other side of skull after impact

42. Brain Injuries (cont’d.)
Concussion- mild traumatic brain injury
More than 300,000 sports related occur annually
Take history, palpation, neurological screening
S/S: confusion, amnesia, LOC, headache, dizzy, poor coordination, distracted, etc.
Tx: should not return to current game or more until cleared, monitor, must follow RTP
Prevention: protective equipment, rule enforcement by referees, keep head up when tackling, education
**state law/UIL guidelines/NATA position statement hw assignment

43. Brain Injuries (cont’d.)
Look up these concussion tools---what they are, how they are used, who uses them, etc:
ImPACT,
King-Devick,
SCAT3,
Glasgow Coma Scale,
Alert/Verbal/Painful/Unresponsive (AVPU)

44. Brain Injuries (cont’d.)
Amnesia
Retrograde or antegrade
Postconcussion syndrome
Follows a concussion
Persistent headache, dizziness, fatigue, irritability, impaired memory, lack of concentration
May persist for days or weeks indicating alternate brain functioning
-Retrograde- loss of memory for events before injury; antegrade- after injury

45. Brain Injuries (cont’d.)
Brain contusions
Result when the brain collides against the skull or is raked over bony irregularities
Hemorrhage
Can lead to rapid deterioration
Subdural, epidural, and intracranial hematoma
Tx: MUST continue to monitor after head injury
subdural- blood between surface of brain and dura mater --may progress rapidly or take hours to days
Epidural- blood between skull and dura mater -- clot formation usually rapid and S/S occur in minutes to hours
Intracranial- pooling of blood from damage within brain -- may occur when cerebral contusion accompanied by significant bleeding

46. Brain Injuries (cont’d.)

47. Brain Injuries (cont’d.)
Secondary impact syndrome
Second head injury occurs before symptoms of a previous injury have been resolved
Rapid swelling and herniation
Prevention is the only cure – very important that athlete with symptoms from head injury does not continue in sport
- Can occur without impact to the head; can occur with blow to chest or back that causes head/brain movement

48. Animation – Head Injuries
Click Here to Play Head Injuries Animation

49. Head Injuries Second Impact Syndrome

50. Conclusion
Injuries to the head and neck can be serious and life threatening
Proper care and management can be the difference between full or partial recovery
A complete understanding of head and brain anatomy, as well as the mechanism of injury, will give the proper tools for accurate assessment