The Head and Face

1. The Head and Face Chapter 22 part 2

2. Preventing Injuries to the Head • Wearing proper protective equipment • Instruct proper techniques of wearing the head and face equipment • Instruct proper techniques of usage of head and face equipment

3. Recognition and Management of Specific Head Injuries • Temporomandibular Joint (TMJ) dislocation • Mandible Fracture • Zygomatic Complex

4. Mandible Fracture • Etiology • Direct blow to lower jaw • Area of fracture often frontal angle. • Symptoms and Signs • Deformity • Loss of occlusion • Pain on biting • Bleeding around teeth • Lower lip anesthesia • Management • Immobilization and refer to physician • Reduction • Four to six weeks immobilization • May return to mild activity • Full activity in 3 to 4 months

5. Zygomatic Complex Fracture • Etiology • Third most common facial fracture. • Direct blow to the cheekbone. • Symptoms and Signs • Obvious deformity can be felt on palpation • Nosebleed (epistaxis) • Double vision (diplopia) • Numbness of cheek • Management • Cold application and referral to physician • Six to eight weeks for healing • Proper protective gear on return to play

6. Recognition and Management of Dental Injuries • Tooth Fracture • Tooth Subluxation • Luxation • Avulsion

7. Tooth Fracture • Etiology • Direct trauma • Symptoms and Signs • Uncomplicated crown fracture • Small portion of tooth is broken no bleeding, pulp not exposed • Complicated crown fracture • Tooth is broken and there is bleeding, pulp is exposed, painful • Root fracture • Occurs below gum line, requires x-ray

8. Tooth Fracture • Management • Do not require immediate visit to dentist – play can continue if tolerated • Place fractured piece in plastic bag. • If bleeding place gauze over fracture site • Root fracture must see dentist after game – dentist will reposition tooth

9. Tooth Subluxation, Luxation, Avulsion • Etiology • Direct trauma • Symptoms and Signs • May be slightly loosened or totally dislodged. • May have pain • Management • No immediate treatment required. • Tooth may be put back in place. • May place tooth in saline or milk if can not reimplant

10. Recognition and Management of Nasal Injuries • Nasal Anatomy • Cavity • Fibrocartilage • Septum • Right and Left Chamber

11. Nasal Fracture • Etiology • Lateral or straight on blow to the nose • Most common fracture of the face • Symptoms and Signs • Profuse bleeding • Immediate swelling • Deformity • Crepitus on palpation • Management • Control bleeding • Splint • Refer to physician for reduction

12. Deviated Septum • Etiology • Compression or lateral trauma • Symptoms and Signs • Nasal pain • Septal hematoma • Management • Compression • Surgical drainage of hematoma • Packed to reduce reformation of hematoma

13. Nosebleed (epistaxis) • Etiology • Direct blow • Sinus infection • High humidity • Allergies • Foreign body lodged in nose • Head injury • Symptoms and Signs • bleeding • Management • Compression • Cold • Head forward

14. Anatomy: External auricle (pinna) external auditory cannal (meatus) Middle (tympanic) Internal (eustachian) Ruptured Tympanic Membrane Swimmer’s Ear Middle Ear infection Impacted Cerumen Recognition and Management ofEar Injuries

15. Auricular Hematoma (cauliflower ear) • Etiology • Seen in boxing, rugby, wrestling • Compression or shearing • Subcutaneous bleeding into the auricular cartilage • Symptoms and Signs • Overlying tissue torn away from cartilage • Bleeding and fluid accumulation (hematoma formation) • Elevated, rounded, white nodular and firm • Management • Prevention – reduce friction, jelly, ear guards • Cold for immediate treatment • aspiration

16. Swimmer’s Ear • Etiology • Infection of the ear canal • Water becomes trapped due to obstructions • Symptoms and Signs • Itching • Discharge • Partial hearing loss • Pain • dizziness • Management • Prevention by drying ears thoroughly • Ear drops (3% boric acid and alcohol solution) • Avoid wind exposure

17. Anatomy: Orbit Eye lid Anterior Chamber Preventing Eye Injuries Shatterproof Eyeglasses Goggles Rec Specs Assessment of the Eye History Observation Palpation Special Tests Visual Acuity Opthalmoscope Recognition and Management of Eye Injuries

18. Orbital Hematoma (black eye) Rupture Globe Hyphema Orbital Fracture Foreign Body in Eye Retinal Detachment Acute Conjunctivitis Hordeolum (sty) Corneal Abrasion Recognition and Management of Eye Injuries

19. Hyphema • Etiology • Collection of blood within anterior chamber of the eye • Caused by blunt blow • Common in racquetball or squash with no eye protection • Symptoms and Signs • Visible reddish tinge in anterior chamber within few hours • Blood settles inferiorly and may fill entire chamber • Vision is impaired or blocked • Management • Prevention by wearing protective eye ware • Immediate referral • Bed rest with elevated head

20. Throat Contusion • Etiology • Direct blow • clotheslining • Symptoms and Signs • Severe pain • Spasmodic coughing, hoarse voice • Difficulty swallowing • Breathing difficulties • Expectoration of frothy blood • cyanosis • Management • Manage airway • EMS • Cold application