Head and Facial Conditions

1. Head and Facial Conditions

2. Anatomy of Head and Face • Bones of skull • Cranium • Protects the brain • Facial • Provide the structure of the face • Form the sinuses, orbits of the eyes, nasal cavity, and the mouth • Scalp • Protective function • Extensive blood supply

3. Anatomy of Head and Face (cont.)

4. Anatomy of Head and Face (cont.) • Brain • Major regions • Cerebral hemispheres • Diencephalon • Brainstem • Cerebellum

5. Anatomy of Head and Face (cont.) • Meninges • Protective tissue that encloses brain and spinal cord • Dura mater; arachnoid mater; pia mater

6. Anatomy of Head and Face (cont.) • Eyes • Conjunctiva • Lacrimal glands • Tunics: sclera; choroid; retina • Cornea

7. Anatomy of Head and Face (cont.) • Nose • Composed of bone and hyaline cartilage • Nasal septum

8. Anatomy of Head and Face (cont.) • Ear • Major areas • Outer ear (auricle and external auditory canal) • Middle ear (tympanic membrane) • Inner ear (labyrinth)

9. Anatomy of Head and Face (cont.)

10. Nerves Cranial nerves Motor functions, sensory functions, or both Numbered and named in accordance with their functions Blood vessels Common carotid Vertebral Anatomy of Head and Face (cont.)

11. Prevention of Head and Facial Injuries • Protective equipment • Helmets • Face guards • Mouth guards • Eye wear • Ear wear • Throat protectors

12. Scalp Injuries • Highly vascularized; bleeds freely • Laceration • Control bleeding • Prevent contamination • Assess for skull fracture (fx) • Management: • If no fx, cleanse, cover, and refer • Abrasions and contusions • Cleanse; ice and pressure • 24 hours: no improvement – refer

13. Injury dependent on: Material properties of skull Thickness of skull Magnitude and direction of force Size of impact area Bone deforms and bends inward Inner border – tensile strain Outer border – compressed Cranial Injury Mechanisms

14. Brain acceleration Shear, tensile, and compression strains within brain Contrecoup injury Cranial Injury Mechanisms (cont.)

15. Cranial Injury Mechanisms (cont.) • Focal injury • Localized damage • Epidural, subdural, or intracerebral hematomas • Diffuse injury • Widespread disruption • Concussion • Accurate assessment of head injury is essential • Conscious, ambulatory individual should not be considered to have only a minor injury

16. Types Linear Comminuted Depressed Basilar Skull Fracture

17. Skull Fracture (cont.) • Potential for varying signs and symptoms (S&S) • Visible deformity–do not be misled by a “goose egg”; a fracture may be under the site • Deep laceration or severe bruise to scalp • Palpable depression or crepitus • Unequal pupils • Raccoon eyes or Battle’s sign

18. Skull Fracture (cont.) • Bleeding or CSF from nose and/or ear • Loss of smell • Loss of sight or major vision disturbances • Unconsciousness 2 minutes after direct trauma to the head • Management: activation of EMS

19. Facial Conditions • Facial soft tissue conditions • Contusions, abrasions, and lacerations are managed the same as elsewhere on the body • Complicated injuries—immediate physician referral

20. Facial Conditions (cont.) • Temporomandibular joint conditions • S&S • Inability to open and/or close mouth (dislocation and meniscus displacement) • Malocclusion • Joint crepitus with opening and closing • Pain with opening and biting • Deviation of the mandible on opening (toward side of injury)

21. Facial Conditions (cont.) • Fractures • Zygomatic • S&S: cheek appears flat or depressed, double vision, numbness in affected cheek • Management: ice, immediate referral • Mandibular • Common: mandibular angle and condyles • S&S: malocclusion, changes in speech, oral bleeding, + tongue blade • Management: ice, immediate referral

22. Facial Conditions (cont.) • Fractures • Maxillary • LeFort fx (upper jaw) • S&S: appearance of longer face, nasal bleeding, malocclusion, nasal deformity, ecchymosis • Management: ice, immediate referral • Facial “red flags”

23. Nasal Conditions • Epistaxis • Anterior – bleeding from anterior septumPosterior – bleeding from lateral wall • Management: ice, mild pressure, slight forward head tilt; nasal plug; 5 minutes – physician referral • Deviated septum • S&S • Consistent difference in airflow between the 2 sides of the nose when one nostril is blocked • Confirm using otoscope • Management: physician referral

24. Nasal Conditions (cont.) • Fractures • Most common: lateral displacement • Range of severity varies • S&S • Asymmetry – especially with lateral force • Epistaxis • Crepitus • Management: control bleeding; refer • Nasal “red flags”

25. Oral and Dental Conditions • Periodontal disease • S&S of gingivitis • Tender, swollen, or bleeding gums • Change in the gums' color from pink to dusky red • Plaque and bacteria that cover the teeth not readily visible

26. Oral and Dental Conditions (cont.) • S&S of periodontitis • Swollen or recessed gums • Unpleasant taste in the mouth • Bad breath • Tooth pain • Drainage or pus around one or more teeth • Management: referral to dentist

27. Oral and Dental Conditions (cont.) • Dental caries (tooth decay) • Primarily caused by plaque...dissolves the tooth enamel…allows bacteria to infect the center of the tooth • S&S • Pain during chewing • Sensitivity to hot/cold foods and beverages • If tooth abscess is present: • Throbbing pain • Sharp or shooting pain • Management: refer to dentist

28. Oral and Dental Conditions (cont.) • Mouth lacerations • Minor lacerations are the same as in other lacerations • Lip and tongue lacerations: require special suturing • Loose teeth • Displaced outward or lateral: attempt to place back in normal position • Intruded: immediate referral to dentist

29. Oral and Dental Conditions (cont.) • Fractured tooth • Enamel: no symptoms • Dentin: pain and increased sensitivity to heat and cold • Pulp or root: severe pain and sensitivity • Management: refer to dentist

30. Oral and Dental Conditions (cont.) • Dislocated tooth • Time is of the essence; refer • Hold tooth by crown • Do not rub the tooth or remove any dirt; milk or saline • Oral and dental “red flags”

31. Ear Conditions • Cauliflower ear (auricular hematoma) • Repeated trauma pulls cartilage away from perichondrium – hematoma forms • Untreated – forms a fibrosis • Management: ice; possible aspiration by physician • Key is prevention! • Impacted cerumen (wax) • Possible hearing loss or muffled hearing • Management: irrigate canal with warm water

33. Ear Conditions (cont.) • Otitis externa (swimmer’s ear) • Bacterial infection to lining of external auditory canal • S&S: pain, itching • Management: ear drops, custom ear plugs • Otitis media • Middle ear infection due to bacteria or virus • S&S: earache, hearing difficulty, possible serous otitis • Management: physician referral

34. Ear Conditions (cont.) • Tympanic membrane rupture • Caused by: • Infection • Direct trauma • Changes in pressure • Loud, sudden noises • Foreign objects in the ear

35. Ear Conditions (cont.) • S&S • Very painful • Tinnitus • Pus-filled or bloody drainage from the ear • Sudden decrease in ear pain followed by drainage • Hearing loss • Management: physician referral • Ear “red flags”

36. Eye Conditions • Preorbital ecchymosis (black eye) • Assessment • Management: ice, referral to ophthalmologist • Foreign bodies • S&S: intense pain, tearing • Management • Not embedded: removal, inspection • Embedded: do not touch, activate EMS

37. Eye Conditions (cont.) • Sty • Infection of sebaceous gland of eyelash • Starts as a red nodule; progresses into a painful pustule • Management: moist heat compress

38. Eye Conditions (cont.) • Conjunctivitis (pink eye) • S&S: itching, burning, watering, red appearance • Management: infectious; refer to physician • Corneal abrasion • S&S: pain, tearing, photophobia, irritated with blinking and eye movement, feeling of “something in the eye” • Management: drops and eye patch

39. Eye Conditions (cont.) • Corneal laceration • S&S: severe pain, decreased visual acuity • Management: cover with no pressure, activate EMS, transport supine or upright

40. Subconjunctival hemorrhage Rupture of small capillaries; sclera appears red, blotchy, inflamed Requires no treatment Hyphema Caused by blunt trauma Hemorrhage into anterior chamber Management: activation of EMS Eye Conditions (cont.)

41. Eye Conditions (cont.) • Detached retina • Can occur with or without trauma • S&S: floaters and light flashes • Management: patch both eyes; refer to ophthalmologist

42. Eye Conditions (cont.) • Orbital “blowout” fracture • Impact from a blunt object, usually larger than the eye orbit • S&S: • Diplopia • Numbness below eye • Lack of eye movement • Recessed downward displacement of globe • Management: ice; immediate referral to physician • Eye “red flags”