The Face Lecture 19

1. The Face Lecture 19

2. 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.

3. 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.

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

5. 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.

6. 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

7. 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

8. 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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10. 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.

11. 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

12. 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

13. 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

14. Fractures - should be referred to dentist ASAP

15. 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

16. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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