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Facial Injuries in Sports and Exercise

Facial Injuries in Sports and Exercise. Epidemiology Scope of the problem. 18% of all athletic injuries Boys: 3 times more facial injuries than girls Most frequently associated sport: Before 1964, Football Now Baseball (40%). Epidemiology: Oral and Facial Trauma. 50 : 50 50% mouth & teeth

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Facial Injuries in Sports and Exercise

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  1. Facial Injuries in Sports and Exercise

  2. EpidemiologyScope of the problem • 18% of all athletic injuries • Boys: 3 times more facial injuries than girls • Most frequently associated sport: • Before 1964, Football • Now Baseball (40%)

  3. Epidemiology:Oral and Facial Trauma • 50 : 50 • 50% mouth & teeth • 50% ears, nose & face • Low Speed • elbows & fists • soft tissue lacerations & contusions • High Speed • balls, pucks, sticks • Bone / tooth fractures

  4. On Field Assessment • ABC’s always come FIRST • Airway • Breathing • Circulation • Don’t get distracted! • C-spine precautions

  5. On Field Assessment • History • How? (MOI) • Other Injuries? • Other symptoms • Respiratory symptoms? • Concussion? • Symptoms • Leakage of fluid (LOF)? • Able to move jaw? • Teeth mesh normally?

  6. Facial Fractures

  7. Mandible and Maxilla fractures • Look for teeth allignment • May require wiring of the teeth

  8. Common Injuries • Nasal Injuries • Ear Injuries • Mouth Injuries • Teeth Injuries • Eye Injuries

  9. Nasal Injuries • Most commonly injured structure of the face • Fractures • Septal deviation • Epistaxis • Septal hematoma • Saddle deformity

  10. Septal Hematoma • Collection of blood b/w cartilage septum & muco-perichondrium • Most often associated with fracture • Dx: grape-like, blue bulge that obstructs nares • Left untreated: can cause “saddle nose” deformity

  11. Nasal Injuries

  12. Common Injuries • Nasal Injuries • Ear Injuries • Mouth Injuries • Teeth Injuries • Eye Injuries

  13. Ear Problems

  14. Auricular Hematoma(“Wrestler’s Ear”)

  15. Auricular Hematoma • Trauma causes bleeding between skin and cartilage • Untreated  • Pressure necrosis • Fibroneocartilage formation • Unsightly scarring • Tx: prompt drainage

  16. Auricular Hematoma Needle Drainage • Need to be promptly aspirated • Have done up to 10 days out • Sterile conditions • +/- Prophylactic antibiotics

  17. Auricular HematomaClot Evacuation • After evacuation, apply compression for 7-10 days to prevent hematoma recurrence

  18. Auricular hematoma Unreliable techniques for compression:

  19. Auricular Hematoma • Best technique for compression: • Sutured tubular gauze • Allows quick return to play • Need to protect it!

  20. Y O U M A K E T H E C A L L OR

  21. Auricular Laceration • Key is to look for cartilage involvement • Anesthesia: no epi • Repair cartilage first w/ 5/6-0 suture • Then repair skin • Tetanus +/- oral abx

  22. Tympanic Membrane Rupture“The Eardrum” • Mechanism of injury • Percussive blow or slap to side of head • Explosions • Travel at altitude • Diving • Boxing, wrestling, martial arts • Water skiing • Surfing • Wake Boarding

  23. Tympanic Membrane Rupture • Symptoms • Painful “pop” • Minor bleeding • Unilateral hearing loss • Can have vertigo &/or nausea • Usually no treatment needed

  24. Otitis Externa“Swimmer’s Ear” • Infection of external auditory canal • Swimmers • Other water sports • Pain with auricle movement • Red, swollen EAC +/- exudate

  25. Otitis Externa Prevention ? Cotton w/ petroleum jelly during swimming

  26. Nasal Injuries • Ear Injuries • Mouth Injuries • Teeth Injuries • Eye Injuries

  27. Lip Lacerations • Mucosa-only lacs heal well w/o sutures • Deep or thru & thru lacerations require layered repair • Vermilion border: approximate border FIRST, then repair remainder (consider referral) • Prophylactic abx or chlorhexidine rinse bid

  28. Tongue lacerations • Irrigate, remove foreign bodies • Repair muscle with 3-0 absorbable if deeper than 5mm • Repair mucosa if still necessary, absorbable is fine

  29. Common Injuries • Nasal Injuries • Ear Injuries • Mouth Injuries • Teeth Injuries • Eye Injuries

  30. Tooth Fracture • Enamel Fracture • Small chips in enamel • Uniform color at fracture site • Dentist referral to smooth rough enamel edges prn • Continue playing!

  31. Tooth Avulsion (“knocked out”) • Pick up tooth by ENAMEL only, not roots • Re-implant w/in 30 min = 90% success • After 6 hrs, <5% • If can’t replace, transport in Save-A-Tooth solution > milk > saline buccal pouch • Prophylactic antibiotics & Tetanus booster • Dentist referral ASAP Aspirated teeth need to be removed by bronchoscopy

  32. Teeth Injuries • Mouthguards • effectively prevent most sports related dental injuries • Encourage athletes to wear mouthpieces!

  33. Common Injuries • Nasal Injuries • Ear Injuries • Mouth Injuries • Teeth Injuries • Eye Injuries

  34. Eye Injury Gallery

  35. Eye Injury Gallery Corneal Abrasion - Topical or oral analgesics - Exam every 24 hours until healed -refer if taking >72 hrs - NOT RECOMMENDED: patch, midriatics -Unknown effectiveness: abx

  36. Eye Injury Gallery Retinal Detachment - Optho referral

  37. Eye Injury Gallery • Superficial • Apply topical analgesic • Remove object w/ needle tip • Deeper: REFER • Superficial • Apply topical analgesic • Remove object w/ needle tip • Deeper: REFER

  38. Eye Injury Gallery Subconjunctival Hemorrhage - Most resolve in 2-3 wks - More extensive ( ~ 360°)  optho referral Hyphema - Optho referral -Bedrest

  39. Eye Injury Gallery Eyelid Laceration “Run, Luke. Run!” Eyelid Laceration After Appropriate Referral

  40. Questions?

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