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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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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.

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

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

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.
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

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

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
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 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

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

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

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

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

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

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