Understanding Head and Face Anatomy and Injuries

2. Chapter 23 The Head and Face

3. Objectives • Upon completion of this chapter, you should be able to: • Describe the anatomy of the head and face • Discuss common injuries to the head, face, teeth, eyes, nose, ears, and scalp • Explain various injuries of the brain that a person might suffer as a result of athletic participation

4. Objectives (cont’d.) • Upon completion of this chapter, you should be able to (cont’d.): • Explain the signs and symptoms of a concussion • Demonstrate on-field management and assessment of concussions

5. The Head and Face Face includes - eyes, ears, nose, jaw, mouth Cranium (skull) - contains brain and spinal cord attachments

6. The Eye • Composed of: • Sclera • Extrinsic and intrinsic eye muscles • Cornea • Choroid coat, iris, pupil • Lens and related structures • Retina • Optic disc and fovea

8. The Eye • Protected by orbital socket of skull, and the eyebrows, eyelids, and eyelashes • Lacrimal secretions (tears) cleanse and moisten on continuous basis • Location of the eyes allows superimposition of images – enables us to see in 3D

9. Pathway of Vision • Images in the light cornea pupil lens where the light rays are bent or refracted retina rods and cones pick up stimulus optic nerve optic chiasma optic tracts occipital lobe of brain for interpretation

11. Pathway of Vision • Sclera- outer layer “white of the eye” • Maintains shape and protects • Muscles that move the eye attach here • Cornea- “window of the eye” • Transparent to permit passage of light rays • Have pain and touch receptors • Injury here can cause scarring and impaired vision

12. Pathway of Vision • Choroid Coat and Iris • Dark pigment of choroid coat prevents light reflection within eye • Eye color related to # and size of melanin pigment in iris • Intrinsic eye muscles within iris contract or dilate to control amount of light entering the pupil

13. Pathway of Vision • Retina- light rays from an object form an image here • Contains rods (dim light) and cones (bright light and color vision) • Lens- disc shaped curvature alters with age • Held in place behind pupil by suspensory ligaments • Aqueous humor and vitreous humor help maintain spherical shape of eye, refracting light rays as they pass through

14. Animation - Vision Click Here to Play Vision Animation

15. Eye Injuries • Most common in sports (basketball, baseball, and racquet sports) and in younger people • Prevention- wearing athletic eyewear • Eyeglasses do not protect and may put athlete at increased risk for injury

16. Eye Injuries • Specks in the eyes- Can cause corneal abrasion • Tx: splash clean water or solution to flush out; if object embedded in the eye, do not remove, cover eye with sterile pad • Blows (contusions) to the eye • Tx: cold compress; consult physician if internal damage suspected • Cuts, Punctures, and abrasions of the eye or eyelid • Do not wash or remove object; bandage to protect, seek medical care

17. Eye Injuries • Orbital blow-out fracture- pain, swelling, double vision, numbness, protrusion of eye • Tx: bandage both eyes, ice, see ophthalmologist immediately • Hyphema- bleeding in anterior chamber • Decreased vision • See ophthalmologist; usually reabsorbs • Conjunctivitis “pink eye”- viral, allergic, and bacterial • Discomfort, redness, inflammation, pain, discharge • Tx: Seek medical care • Sty- infection of a gland along the eyelid

18. The Ear Outer ear - Visible part of ear - Tiny hairs trap dust, pollen, foreign objects Middle ear - Conducts sound to inner ear - Passes on the vibrations of sound from compression and decompression of outside air Inner ear - A maze of winding passageways (labyrinth) - Posture and directional info registered by relevant cells and conveyed by nerve fibers to the brain

20. Animation - Hearing Click Here to Play Hearing Animation

21. Injuries to the Ear • Cauliflower ear • Deformity caused by outer ear cartilage damage - blood collects and thickens outer ear • Tx: drain and immediate compression to prevent deformity • Swimmer’s ear • Infection of skin covering outer ear canal usually caused by excessive water exposure • S/S: feels “full”, may itch, swell, drainage, pain, may swell shut • Keep dry, wear earplug to keep water out

22. Injuries to the Ear • Foreign bodies lodged in the ear • S/S: pain, drainage, fever, nausea and vomiting, coughing, dizziness, foul odor from infection • Tx: if don’t fall out naturally, gentle flushing with warm water; live insects killed before removal; surgery occasionally • Tympani (eardrum) rupture • Perforation of tympanic membrane • S/S: pain until rupture occurs and relieves pressure; drainage

23. The Nose • Composition of bone, cartilage, and skin • Projects from frontal bone of cranium and maxillae of face • Serves as an air passage between nostrils and throat, and sense of smell • Warms, moistens, and filters air that enters nostrils and travels to lungs • Can detect ~10,000 smells • Highly vascular

25. Injuries to the Nose • Epistaxis-Nosebleed • Dryness or trauma, high blood pressure, cholesterol, aging, tumors, medication, leukemia, liver failure • Sit, lean forward, squeeze soft portion, ice pack • Nasal fractures and septal deviations • Break in bone or damage to cartilaginous structures • S/S: deformity, swelling, laceration, ecchymosis, epistaxis, cerebrospinal fluid (CSF) leakage • Tx: control bleeding, refer

26. Injuries to the Nose

27. The Mouth and Jaw • Mouth - Soft palate - Hard palate • Mucous Membranes • Tongue, lips, cheeks • 32 teeth • Jaw - Maxilla Attached to skull at Temporomandibular Joint - Mandible (TMJ)

29. Injuries to the Mouth and Jaw • Soft-tissue injuries • Cuts or lacerations to the lips, tongue, inside of the mouth, or face • Dental injuries • Fractured teeth, partially or totally knocked out, tooth-related structures (ie braces) • Jaw-related or bone-related injuries • Contusions, and alveolar fractures (houses teeth), jaw fractures

30. Injuries to the Mouth and Jaw • Jaw Fractures • Usually 2 fx sites – direct and indirect • S/S: severe pain, swelling, blood at base of teeth, deformity, tenderness, numbness • Tx: immobilization, ice, treat for shock, immediate physician referral • Temporomandibular Joint- sprain, dislocation, sprain fx • S/S: inability to close mouth, severe pain, deformity, swelling • Tx: Ice, refer to physician

31. Injuries to the Mouth and Jaw

32. Injuries to the Mouth and Jaw • Teeth • S/S: loose, chipped, or missing teeth, pain in involved teeth and gums • Tx: place back in socket and have them hold to keep it in place, refer to dentist immediately • If can’t reinsert, wrap in sterile, moist gauze for them to take to dentist

33. The Head • Cranium consists of: • Frontal bone - strong • Temporal bone - weaker • Mastoid sinuses • Occipital bone • Foramen magnum- spinal cord passed through here • Parietal bone • Sutures- immovable joints that join all cranial bones

36. https://www.youtube.com/watch?v=8F9jXYOH2c0

37. The Head (cont’d.) • The brain • Brainstem- controls life sustaining functions (ie. breathing and heartbeat) • Cerebellum- controls muscular coordination and complex actions (throwing, driving, balance) • Cerebrum- higher thinking • Divided into lobes which have specific functions • Meninges- pad brain from impact • Cerebrospinal fluid also protects, carries nutrients to and removes wastes from brain cells

39. Head Injuries • Approximately half U.S. trauma-related deaths are due to head injuries • Head injuries include: • Scalp injuries- Contusions and lacerations • Bleeding, tenderness, swelling, hematoma (“goose egg”) • Skull fractures- Uncommon but do occur • Bleeding, CSF drainage from ear or nose • Tx: immobilize, control bleeding, treat for shock, EMS

40. Brain Injuries • Most serious threat to an athlete • Usually result from movement of the brain within the skull • Forceful impact causing temporary dysfunction (cerebral concussion) • Transmission of force from skull to underlying tissue causing bruising or laceration (cerebral contusion) • Contusion or lacerations • Contrecoup Injury

42. Brain Injuries (cont’d.) • Concussion- mild traumatic brain injury • More than 300,000 sports related occur annually • Take history, palpation, neurological screening • S/S: confusion, amnesia, LOC, headache, dizzy, poor coordination, distracted, etc. • Tx: should not return to current game or more until cleared, monitor, must follow RTP • Prevention: protective equipment, rule enforcement by referees, keep head up when tackling, education

43. Brain Injuries (cont’d.) • Look up these concussion tools---what they are, how they are used, who uses them, etc: • ImPACT, • King-Devick, • SCAT3, • Glasgow Coma Scale, • Alert/Verbal/Painful/Unresponsive (AVPU)

44. Brain Injuries (cont’d.) • Amnesia • Retrograde or antegrade • Postconcussion syndrome • Follows a concussion • Persistent headache, dizziness, fatigue, irritability, impaired memory, lack of concentration • May persist for days or weeks indicating alternate brain functioning

45. Brain Injuries (cont’d.) • Brain contusions • Result when the brain collides against the skull or is raked over bony irregularities • Hemorrhage • Can lead to rapid deterioration • Subdural, epidural, and intracranial hematoma • Tx: MUST continue to monitor after head injury

46. Brain Injuries (cont’d.)

47. Brain Injuries (cont’d.) • Secondary impact syndrome • Second head injury occurs before symptoms of a previous injury have been resolved • Rapid swelling and herniation • Prevention is the only cure – very important that athlete with symptoms from head injury does not continue in sport

48. Animation – Head Injuries Click Here to Play Head Injuries Animation

49. Head Injuries • Second Impact Syndrome • https://www.youtube.com/watch?v=Ai5AXF7XKw8

50. Conclusion • Injuries to the head and neck can be serious and life threatening • Proper care and management can be the difference between full or partial recovery • A complete understanding of head and brain anatomy, as well as the mechanism of injury, will give the proper tools for accurate assessment