1. HEAD AND FACE
CHAPTER 22

2. ANATOMY

3. SCALP Scalp Skin Connective Tissue Apeneurosis Loose Connective Tissue
Periosteum

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

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

6. 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

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

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

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

10. HEAD INJURIES

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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!

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

18. 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!

19. 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.

20. FACIAL INJURIES

21. 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

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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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