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Head and Facial Conditions
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Anatomy of Head and Face
Bones of skull Cranium Protects the brain Facial Provide the structure of the face Form the sinuses, orbits of the eyes, nasal cavity, and the mouth Scalp Protective function Extensive blood supply
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Anatomy of Head and Face (cont.)
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Anatomy of Head and Face (cont.)
Brain Major regions Cerebral hemispheres Diencephalon Brainstem Cerebellum
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Anatomy of Head and Face (cont.)
Meninges Protective tissue that encloses brain and spinal cord Dura mater; arachnoid mater; pia mater
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Anatomy of Head and Face (cont.)
Eyes Conjunctiva Lacrimal glands Tunics: sclera; choroid; retina Cornea
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Anatomy of Head and Face (cont.)
Nose Composed of bone and hyaline cartilage Nasal septum
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Anatomy of Head and Face (cont.)
Ear Major areas Outer ear (auricle and external auditory canal) Middle ear (tympanic membrane) Inner ear (labyrinth)
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Anatomy of Head and Face (cont.)
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Anatomy of Head and Face (cont.)
Nerves Cranial nerves Motor functions, sensory functions, or both Numbered and named in accordance with their functions Blood vessels Common carotid Vertebral
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Prevention of Head and Facial Injuries
Protective equipment Helmets Face guards Mouth guards Eye wear Ear wear Throat protectors
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Scalp Injuries Highly vascularized; bleeds freely Laceration
Control bleeding Prevent contamination Assess for skull fracture (fx) Management: If no fx, cleanse, cover, and refer Abrasions and contusions Cleanse; ice and pressure 24 hours: no improvement – refer
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Cranial Injury Mechanisms
Injury dependent on: Material properties of skull Thickness of skull Magnitude and direction of force Size of impact area Bone deforms and bends inward Inner border – tensile strain Outer border – compressed
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Cranial Injury Mechanisms (cont.)
Brain acceleration Shear, tensile, and compression strains within brain Contrecoup injury
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Cranial Injury Mechanisms (cont.)
Focal injury Localized damage Epidural, subdural, or intracerebral hematomas Diffuse injury Widespread disruption Concussion Accurate assessment of head injury is essential Conscious, ambulatory individual should not be considered to have only a minor injury
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Skull Fracture Types Linear Comminuted Depressed Basilar
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Skull Fracture (cont.) Potential for varying signs and symptoms (S&S)
Visible deformity–do not be misled by a “goose egg”; a fracture may be under the site Deep laceration or severe bruise to scalp Palpable depression or crepitus Unequal pupils Raccoon eyes or Battle’s sign
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Skull Fracture (cont.) Management: activation of EMS
Bleeding or CSF from nose and/or ear Loss of smell Loss of sight or major vision disturbances Unconsciousness 2 minutes after direct trauma to the head Management: activation of EMS
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Facial Conditions Facial soft tissue conditions
Contusions, abrasions, and lacerations are managed the same as elsewhere on the body Complicated injuries—immediate physician referral
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Facial Conditions (cont.)
Temporomandibular joint conditions S&S Inability to open and/or close mouth (dislocation and meniscus displacement) Malocclusion Joint crepitus with opening and closing Pain with opening and biting Deviation of the mandible on opening (toward side of injury)
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Facial Conditions (cont.)
Fractures Zygomatic S&S: cheek appears flat or depressed, double vision, numbness in affected cheek Management: ice, immediate referral Mandibular Common: mandibular angle and condyles S&S: malocclusion, changes in speech, oral bleeding, + tongue blade
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Facial Conditions (cont.)
Fractures Maxillary LeFort fx (upper jaw) S&S: appearance of longer face, nasal bleeding, malocclusion, nasal deformity, ecchymosis Management: ice, immediate referral Facial “red flags”
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Nasal Conditions Epistaxis Deviated septum
Anterior – bleeding from anterior septum Posterior – bleeding from lateral wall Management: ice, mild pressure, slight forward head tilt; nasal plug; 5 minutes – physician referral Deviated septum S&S Consistent difference in airflow between the 2 sides of the nose when one nostril is blocked Confirm using otoscope Management: physician referral
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Nasal Conditions (cont.)
Fractures Most common: lateral displacement Range of severity varies S&S Asymmetry – especially with lateral force Epistaxis Crepitus Management: control bleeding; refer Nasal “red flags”
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Oral and Dental Conditions
Periodontal disease S&S of gingivitis Tender, swollen, or bleeding gums Change in the gums' color from pink to dusky red Plaque and bacteria that cover the teeth not readily visible
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Oral and Dental Conditions (cont.)
S&S of periodontitis Swollen or recessed gums Unpleasant taste in the mouth Bad breath Tooth pain Drainage or pus around one or more teeth Management: referral to dentist
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Oral and Dental Conditions (cont.)
Dental caries (tooth decay) Primarily caused by plaque...dissolves the tooth enamel…allows bacteria to infect the center of the tooth S&S Pain during chewing Sensitivity to hot/cold foods and beverages If tooth abscess is present: Throbbing pain Sharp or shooting pain Management: refer to dentist
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Oral and Dental Conditions (cont.)
Mouth lacerations Minor lacerations are the same as in other lacerations Lip and tongue lacerations: require special suturing Loose teeth Displaced outward or lateral: attempt to place back in normal position Intruded: immediate referral to dentist
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Oral and Dental Conditions (cont.)
Fractured tooth Enamel: no symptoms Dentin: pain and increased sensitivity to heat and cold Pulp or root: severe pain and sensitivity Management: refer to dentist
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Oral and Dental Conditions (cont.)
Dislocated tooth Time is of the essence; refer Hold tooth by crown Do not rub the tooth or remove any dirt; milk or saline Oral and dental “red flags”
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Ear Conditions Cauliflower ear (auricular hematoma)
Repeated trauma pulls cartilage away from perichondrium – hematoma forms Untreated – forms a fibrosis Management: ice; possible aspiration by physician Key is prevention! Impacted cerumen (wax) Possible hearing loss or muffled hearing Management: irrigate canal with warm water
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Ear Conditions (cont.) Otitis externa (swimmer’s ear) Otitis media
Bacterial infection to lining of external auditory canal S&S: pain, itching Management: ear drops, custom ear plugs Otitis media Middle ear infection due to bacteria or virus S&S: earache, hearing difficulty, possible serous otitis Management: physician referral
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Ear Conditions (cont.) Tympanic membrane rupture Caused by: Infection
Direct trauma Changes in pressure Loud, sudden noises Foreign objects in the ear
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Ear Conditions (cont.) Ear “red flags” S&S
Very painful Tinnitus Pus-filled or bloody drainage from the ear Sudden decrease in ear pain followed by drainage Hearing loss Management: physician referral Ear “red flags”
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Eye Conditions Preorbital ecchymosis (black eye) Foreign bodies
Assessment Management: ice, referral to ophthalmologist Foreign bodies S&S: intense pain, tearing Management Not embedded: removal, inspection Embedded: do not touch, activate EMS
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Eye Conditions (cont.) Sty Infection of sebaceous gland of eyelash
Starts as a red nodule; progresses into a painful pustule Management: moist heat compress
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Eye Conditions (cont.) Conjunctivitis (pink eye) Corneal abrasion
S&S: itching, burning, watering, red appearance Management: infectious; refer to physician Corneal abrasion S&S: pain, tearing, photophobia, irritated with blinking and eye movement, feeling of “something in the eye” Management: drops and eye patch
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Eye Conditions (cont.) Corneal laceration
S&S: severe pain, decreased visual acuity Management: cover with no pressure, activate EMS, transport supine or upright
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Eye Conditions (cont.) Subconjunctival hemorrhage Hyphema
Rupture of small capillaries; sclera appears red, blotchy, inflamed Requires no treatment Hyphema Caused by blunt trauma Hemorrhage into anterior chamber Management: activation of EMS
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Eye Conditions (cont.) Detached retina
Can occur with or without trauma S&S: floaters and light flashes Management: patch both eyes; refer to ophthalmologist
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Eye Conditions (cont.) Orbital “blowout” fracture Eye “red flags”
Impact from a blunt object, usually larger than the eye orbit S&S: Diplopia Numbness below eye Lack of eye movement Recessed downward displacement of globe Management: ice; immediate referral to physician Eye “red flags”
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