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The Face Lecture 19. Facial Injuries. Injuries to the cheek, nose, lips and jaw are very common in sports - especially those with moving objects, and or contact sports. Wearing proper protective equipment can prevent many injuries.

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The Face Lecture 19

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The face lecture 19

The Face Lecture 19

Facial injuries

Facial Injuries

  • Injuries to the cheek, nose, lips and jaw are very common in sports - especially those with moving objects, and or contact sports.

  • Wearing proper protective equipment can prevent many injuries.

  • Because the face has a vast arterial system , lacerations bleed freely and rapid swelling often occurs.

Soft tissue injuries

Soft Tissue Injuries

  • contusions , abrasions , lacerations are all managed the same on the face as in the rest of the body.

  • Minor lacerations ( less than 1 inch long and 1/8th inch deep) can be closed with a steristrip other wise sutures should be done.

Facial fractures

Facial Fractures

  • Direct impact can fracture facial bones including the mandible (the jaw), maxilla (upper jaw) zygomatic (cheek) or the nasal bones

Nasal fractures

Nasal Fractures-

  • most common facial fracture in sport , it is particularly susceptible to lateral displacement.

  • Nose may appear flattened and lose its symmetry.

  • Deformity is usually present- especially with a lateral blow

  • Nosebleeds are almost always seen.

The face lecture 19

  • There may be crepitus over the nasal bridge and ecchymosis under the eyes

  • Rx- Control the bleeding , apply ie. to limit swelling and refer to Physician

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  • Zygomatic Fractures

  • With direct impact to the zygomatic bone the cheek will appear flat or depressed

  • Swelling and ecchymosis about the eye may interfere with vision

  • Rx- Refer to doctor ASAP

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  • Mandibular fractures are the third most common fracture associated with sports participation behind the nasal and zygotic fractures.

  • Seldom occur as isolated fractures - but usually as double fractures or fracture -dislocation.

  • In all fractures it is important to maintain an open airway, dress wounds , immobilize as best as possible and refer to physician.

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Nasal injuries

Nasal Injuries

  • Epistaxis - nose bleed - in most cases bleeding will stop spontaneously by applying mild pressure at the nasal bone, ice may be used to stop persistent bleeding , Nasal plugs may be used - if bleeding continues for more than five minutes refer to physician.

Oral and dental injuries

Oral and Dental Injuries

  • To prevent dental injuries - mouthgaurds should be used at all times

  • Lacerations of the mouth -

  • RX- Apply direct pressure - cleanse the area with a saline solution

  • Lacerations that extend completely through the lip or large tongue lacerations - require special suturing

The face lecture 19

  • Dental Injuries - when the tooth is displaced outwardly or laterally - try to place tooth back into its normal position

  • when a tooth is displaced inwardly - it should be left alone

  • all dental injuries should be seen by a dentist ASAP

  • Teeth that have been totally avulsed from their socket can often be located

  • These teeth can be saved but time is of the essence

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  • Do not touch the root or brush the tooth off

  • If the tooth is rinsed in milk or saline and replace intraorally with 30 minutes the prognosis for successful replanting is 90%

  • Replanting that occurs after 2 hours results in a 95% failure rate

  • The tooth can be replace or place under the tongue for transport to the dentist

  • Tap water or drinking water will damage the root and compromise replanting , hense should not be used

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  • Fractures - should be referred to dentist ASAP

Ear injuries

Ear Injuries

  • Cauliflower ear- a relatively minor injury caused by repeated trauma - a hematoma forms between the perichondrium and the cartilage of the outer ear

The face lecture 19

  • The hematoma should be aspirated by a physician to avoid permanent cartilage damage

  • If left untreated the hematoma forms a fibrosis in the overlying skin , leading to necrosis of the auricular cartilage , resulting in the cauliflower ear appearance

  • Protective headgear in sports such as boxing, wrestling, water polo and rugby is designed to prevent trauma to the ear but must be worn regularly to be effective

  • Rx - PIER

Eye injuries

Eye Injuries

  • Many eye injuries can be prevented with proper protective wear

  • Especially true in racquet sports (squash, racquetball)

  • Periorbitaal Ecchymosis ( Black Eye) - swelling and hemorrhage into the surrounding eyelids and area

  • Inspect eye for obvious abnormalities and palpate for possible orbital fractures

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  • Inspect the anterior chamber of the eye for bleeding

  • Check the ability of individual to focus

  • Ice the eye by using crushed ice or ice water in a latex surgical glove , do not use chemical bags

  • Rx- Refer to ophthalmologist for further examination

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  • Foreign bodies- dust or dirt can lead to intense pain and tearing

  • The foreign body if not imbedded should be removed

  • The eye should be inspected for any scratches , abrasions or lacerations

  • If unable to remove -patch both eyes with a sterile gauze pad and refer to physician

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  • Conjunctivitis ( Pinkeye)

  • A bacterial infection of the conductive (the membrane between the inner lining of the eye lid and the anterior eyeball)

  • The infection leads to itching , burning and watering of the eye, causing the conjunctiva to become inflamed and red - giving it a pinky appearance

  • Rx- This condition is highly infectious - refer to physician

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  • Corneal Abrasion - a foreign body may scratch the cornea - resulting in pain and tearing

  • Blinking and movement aggravates this condition

  • A corneal abrasion is best seen by using a fluorescein dye strip - the dye alluminates the abrasion

  • Rx- involves an topical ointment and an eye patch

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  • Detached Retina - damage to the posterior segment of the eye can occur with or without trauma to the anterior segment

  • A detached retina occurs when fluid seeps into the retina; break and separates the neurosensory retina from the retinal epithelium

  • This can occur days or weeks after the initial trauma

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  • Condition is often described as a curtain falling over their eye - or seeing flashes of light going on and off

  • Rx - Immediate referral to ophthalmologist

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