1. Head and Facial Conditions

2. 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

3. Anatomy of Head and Face (cont.)

4. Anatomy of Head and Face (cont.)
Brain
Major regions
Cerebral hemispheres
Diencephalon
Brainstem
Cerebellum

5. Anatomy of Head and Face (cont.)
Meninges
Protective tissue that encloses brain and spinal cord
Dura mater; arachnoid mater; pia mater

6. Anatomy of Head and Face (cont.)
Eyes
Conjunctiva
Lacrimal glands
Tunics: sclera; choroid; retina
Cornea

7. Anatomy of Head and Face (cont.)
Nose
Composed of bone and hyaline cartilage
Nasal septum

8. Anatomy of Head and Face (cont.)
Ear
Major areas
Outer ear (auricle and external auditory canal)
Middle ear (tympanic membrane)
Inner ear (labyrinth)

9. Anatomy of Head and Face (cont.)

10. 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

11. Prevention of Head and Facial Injuries
Protective equipment
Helmets
Face guards
Mouth guards
Eye wear
Ear wear
Throat protectors

12. 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

13. 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

14. Cranial Injury Mechanisms (cont.)
Brain acceleration
Shear, tensile, and compression strains within brain
Contrecoup injury

15. 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

16. Skull Fracture
Types
Linear
Comminuted
Depressed
Basilar

17. 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

18. 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

19. Facial Conditions Facial soft tissue conditions
Contusions, abrasions, and lacerations are managed the same as elsewhere on the body
Complicated injuries—immediate physician referral

20. 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)

21. 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

22. 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”

23. 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

24. 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”

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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”

31. 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

33. 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

34. Ear Conditions (cont.) Tympanic membrane rupture Caused by: Infection
Direct trauma
Changes in pressure
Loud, sudden noises
Foreign objects in the ear

35. 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”

36. 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

37. Eye Conditions (cont.) Sty Infection of sebaceous gland of eyelash
Starts as a red nodule; progresses into a painful pustule
Management: moist heat compress

38. 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

39. Eye Conditions (cont.) Corneal laceration
S&S: severe pain, decreased visual acuity
Management: cover with no pressure, activate EMS, transport supine or upright

40. 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

41. Eye Conditions (cont.) Detached retina
Can occur with or without trauma
S&S: floaters and light flashes
Management: patch both eyes; refer to ophthalmologist

42. 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”