Chapter 6 Chapter 6 Facial injuriesFacial injuries

ObjectivesObjectives

Describe the basic anatomy of the face. Describe the basic anatomy of the face. Describe how common facial injuries Describe how common facial injuries

occur. occur. Explain the common types of facial Explain the common types of facial

injuries and how to prevent them. injuries and how to prevent them. Explain common steps of care for Explain common steps of care for

treating facial injuries. treating facial injuries.

AnatomyAnatomy 18 bones (some 18 bones (some

are in pairs)are in pairs) Major bonesMajor bones

MandibleMandible Maxilla (2)Maxilla (2) Zygomatic (2)Zygomatic (2) FrontalFrontal

Other significant Other significant bonesbones Nasal (2)Nasal (2) SphenoidSphenoid EthmoidEthmoid

The EyeThe Eye

Sits in orbit or orbital Sits in orbit or orbital foramenforamen

Mostly hidden, Mostly hidden, protected on 3 sidesprotected on 3 sides

Lack of eye movement Lack of eye movement can indicate head or can indicate head or eye injuryeye injury

2 chambers2 chambers Anterior Anterior PosteriorPosterior Both filled with fluid, gives eye Both filled with fluid, gives eye

its rounded shapeits rounded shape Any injury that causes fluid Any injury that causes fluid

leakage can cause permanent leakage can cause permanent

damage,damage, possible blindnesspossible blindness

The eyeThe eye Parts of the eyeParts of the eye

Sclera- white outer Sclera- white outer coveringcovering

Change in color of Change in color of sclera can indicate sclera can indicate liver problems, lack of liver problems, lack of oxygen, or poisoningoxygen, or poisoning

Cornea-center clear Cornea-center clear portion of the portion of the coveringcovering

Protects important Protects important structures from injurystructures from injury

Covers iris and pupil Covers iris and pupil and admits light to the and admits light to the interior eyeinterior eye

The eyeThe eye Parts-continuedParts-continued

Iris-colored portion of the eyeIris-colored portion of the eye Responds to light to change size of the pupilResponds to light to change size of the pupil

Pupil-the opening of the eye, can dilate and Pupil-the opening of the eye, can dilate and constrictconstrict

Lens-anterior locationLens-anterior location Focuses the light rays entering the eye onto the Focuses the light rays entering the eye onto the

retinaretina

Conjunctiva- lining of inner surface of the Conjunctiva- lining of inner surface of the eyelid continues over the eyeball eyelid continues over the eyeball

The eyeThe eye

Posterior portionPosterior portion RetinaRetina

Lines back of the eyes, contains rods and conesLines back of the eyes, contains rods and cones Rods provide black and white visionRods provide black and white vision Cones-colorCones-color

Optic nerveOptic nerve Send signals to the brain where vision occursSend signals to the brain where vision occurs Damage to optic nerve can cause blindnessDamage to optic nerve can cause blindness

The eyeThe eye

Tear ductsTear ducts Superior lateral edge of eyeSuperior lateral edge of eye Drain diagonally across the eyeDrain diagonally across the eye

Vision measurementVision measurement 20/2020/20 Nearsighted- can see close objects, but not Nearsighted- can see close objects, but not

farfar Farsighted- can see objects far away, but Farsighted- can see objects far away, but

not nearnot near

The earThe ear 3 areas3 areas ExternalExternal

PinnaPinna Projecting portion of the external earProjecting portion of the external ear Catch sound, funnel sound into auditory canalCatch sound, funnel sound into auditory canal

Auditory canalAuditory canal Carry sound into tympanic membraneCarry sound into tympanic membrane

Tympanic membraneTympanic membrane Eardrum- contains sound producing organsEardrum- contains sound producing organs Ear wax-keeps dirt outEar wax-keeps dirt out

The middle earThe middle earContains anvil, stirrup, and hammerContains anvil, stirrup, and hammer

The inner earThe inner ear InnerInner Primary Primary

function is function is transmittal of transmittal of vibrations and vibrations and balancebalance CochleaCochlea IncusIncus MalleusMalleus Semicircular Semicircular

canalscanals StapesStapes Auditory nerveAuditory nerve

The noseThe nose

Nasal bones (2)Nasal bones (2) Bridge Bridge Attach to the frontal Attach to the frontal

bonebone About an inch longAbout an inch long Rest of the nose is Rest of the nose is

made up of cartilagemade up of cartilage

The noseThe nose

SeptumSeptum Cartilage that separates right and left sides Cartilage that separates right and left sides

of the noseof the nose

PalatePalate Roof of the mouth-separates mouth from the Roof of the mouth-separates mouth from the

nosenose

The mouthThe mouth MandibleMandible Lower jawLower jaw

MaxillaMaxilla Upper jawUpper jaw

Temperomandibular joint Temperomandibular joint (TMJ) (TMJ) Only moveable joint in the Only moveable joint in the

faceface Tongue Tongue Palate (roof of mouth)Palate (roof of mouth) TeethTeeth

Chew food, give face Chew food, give face shapeshape

32 adult permanent teeth32 adult permanent teeth

The teethThe teeth CrownCrown

Above the gumlineAbove the gumline Enamel covers tooth to protect against tooth Enamel covers tooth to protect against tooth

decay decay

Neck Neck RootRoot

Contains pulp and dentinContains pulp and dentin Dentin-hard, bony portion of the toothDentin-hard, bony portion of the tooth Pulp-soft portion containing nerve and blood Pulp-soft portion containing nerve and blood

supplysupply

The teethThe teeth NervesNerves

Sensitive to pain, pressure, and temperatureSensitive to pain, pressure, and temperature

Blood supplyBlood supply Brings oxygen and food to the tooth to keep Brings oxygen and food to the tooth to keep

it aliveit alive Live tooth=whiteLive tooth=white Dead tooth=dark greyDead tooth=dark grey

Preventing Facial InjuriesPreventing Facial Injuries

Common senseCommon sense Catcher/facemaskCatcher/facemask HelmetHelmet MouthguardMouthguard Goggles/protective Goggles/protective

eyeweareyewear HeadgearHeadgear

Treating eye injuriesTreating eye injuries

Best to err on side of Best to err on side of caution and refercaution and refer

Consider all possible Consider all possible injuries (head)injuries (head)

Best to cover both Best to cover both eyes to reduce eyes to reduce movementmovement

Corneal Abrasion or Corneal Abrasion or LacerationLaceration A scratch of the outer A scratch of the outer

layer of the cornealayer of the cornea Laceration is deeper and Laceration is deeper and

more severemore severe Sensation of something Sensation of something

in the eyein the eye Tearing and Tearing and

photosensitivephotosensitive Untreated can cause Untreated can cause

infection or permanent infection or permanent vision problemsvision problems

Treat with patch and/or Treat with patch and/or antibiotic ointmentantibiotic ointment

Detached retinaDetached retina Caused by blow to eye Caused by blow to eye

or even a hard sneezeor even a hard sneeze S/S- pain, athlete sees S/S- pain, athlete sees

sparks, lights, and sparks, lights, and flashesflashes

May have foggy or May have foggy or unclear visionunclear vision

Physician can perform Physician can perform laser surgery to repairlaser surgery to repair

Can cause blindness if Can cause blindness if not repaired promptlynot repaired promptly

Black eyeBlack eye

ContusionContusion Caused by bleeding Caused by bleeding

and discoloration and discoloration under the skinunder the skin

Swelling and pain, no Swelling and pain, no visual impairmentvisual impairment

IceIce Any other symptoms Any other symptoms

should be referredshould be referred

Foreign bodiesForeign bodies

Causes tears, Causes tears, attempting to wash it attempting to wash it awayaway

Flush with warm Flush with warm waterwater

Can lift upper lid and Can lift upper lid and invertinvert

If object cannot be If object cannot be removed, must referremoved, must refer

Patch both eyesPatch both eyes

Embedded objectsEmbedded objects

Care received will Care received will determine quality of determine quality of future visionfuture vision

Place eye shield over Place eye shield over eyes immediately eyes immediately and referand refer

Do not remove Do not remove object, stabilize with object, stabilize with bulky dressingbulky dressing

Subconjunctival Subconjunctival hemorrhagehemorrhage

Ruptures of the small Ruptures of the small blood vessels of eyesblood vessels of eyes

Can be caused by direct Can be caused by direct blow, poke, or constant blow, poke, or constant coughing/pressurecoughing/pressure

Looks very painful, but Looks very painful, but notnot

Refer to be safeRefer to be safe No treatmentNo treatment

Hyphema (anterior Hyphema (anterior chamber hemorrhage)chamber hemorrhage) Bleeding within the eyeBleeding within the eye Blood pools, can be Blood pools, can be

seen under corneaseen under cornea Pain and inability to seePain and inability to see Cover both eyes, DO Cover both eyes, DO

NOT ICENOT ICE Can cause permanent Can cause permanent

damage, blindness, or damage, blindness, or develop cataractsdevelop cataracts

Blowout fractureBlowout fracture Forces eye backwards into Forces eye backwards into

socketsocket Can cause double visionCan cause double vision May not feel a lot of pain May not feel a lot of pain

due to nerve damagedue to nerve damage May have numbing of jaw May have numbing of jaw

and upper lip of injured sideand upper lip of injured side Immediate swelling and Immediate swelling and

discolorationdiscoloration Bleeding may make it Bleeding may make it

difficult to breath through difficult to breath through nosenose

Call 911 and control Call 911 and control bleedingbleeding

Can cause permanent vision Can cause permanent vision problems including problems including glaucoma and cataractsglaucoma and cataracts

No competition for several months

Fracture of orbital roofFracture of orbital roof

Caused by direct blowCaused by direct blow Causes pain, headache, hematoma over Causes pain, headache, hematoma over

eye, and s/s of concussioneye, and s/s of concussion Possible bloody nose and cerebrospinal Possible bloody nose and cerebrospinal

fluid may leak from nosefluid may leak from nose Needs immediate medical attentionNeeds immediate medical attention No return to competition for 1 yearNo return to competition for 1 year

Sinus fractureSinus fracture

Usually caused by direct blowUsually caused by direct blow S/S-headache, dizziness, and S/S-headache, dizziness, and

unsteadiness, painunsteadiness, pain Crepitus when palpatedCrepitus when palpated Ice and referIce and refer

Dislodged contact lensDislodged contact lens 2 types of lens: 2 types of lens:

hard/softhard/soft Cannot be lost behind Cannot be lost behind

the eyethe eye Hard displacement Hard displacement

most uncomfortable, most uncomfortable, soft harder to put back soft harder to put back in placein place

Clean before returning Clean before returning to eyeto eye

Do not allow athlete to Do not allow athlete to put contact in mouthput contact in mouth

Eyelid lacerationEyelid laceration

Control bleeding with Control bleeding with direct pressuredirect pressure

Check visionCheck vision Tear duct can be Tear duct can be

injuredinjured Refer for repair by Refer for repair by

physicianphysician

Ruptured globeRuptured globe Usually caused by direct blow Usually caused by direct blow

by object small enough to by object small enough to enter the eye (golf ball)enter the eye (golf ball)

Many complications/injuriesMany complications/injuries Cover eye with shield that Cover eye with shield that

does not allow external does not allow external pressurepressure

ER immediatelyER immediately No return to competition for No return to competition for

monthsmonths

Ear injuriesEar injuries

Laceration of the pinnaLaceration of the pinna

Most often caused by Most often caused by earring being torn from earring being torn from earear

Control bleeding, iceControl bleeding, ice Refer for stitches if Refer for stitches if

necessarynecessary If portion is torn off, If portion is torn off,

place piece in sterile place piece in sterile gauze, put in plastic gauze, put in plastic bag, place on icebag, place on ice

Cauliflower Ear Cauliflower Ear (hematoma auris)(hematoma auris)

Caused by internal bleeding, usually a Caused by internal bleeding, usually a result of frictionresult of friction Swelling, redness, and pain commonSwelling, redness, and pain common

Common in wrestlers due to ears being Common in wrestlers due to ears being pushed into matpushed into mat

As ear heals, excess growth of reparative As ear heals, excess growth of reparative tissue (scar tissue)tissue (scar tissue)

Distortion of pinna looks like cauliflowerDistortion of pinna looks like cauliflower

Cauliflower earCauliflower ear Treatment: ice and Treatment: ice and

compressioncompression Physician may lance or Physician may lance or

drain and compress drain and compress with a moldable with a moldable materialmaterial

May need to do tissue May need to do tissue removal if severeremoval if severe

Petroleum jelly applied Petroleum jelly applied to ears can reduce to ears can reduce friction and prevent friction and prevent

Otitis Externa Otitis Externa (swimmer’s ear)(swimmer’s ear)

Inflammation of the ear canal caused by fluid in the ear (usually water)Inflammation of the ear canal caused by fluid in the ear (usually water) Causes pain, itching, hearing loss and possible smelly dischargeCauses pain, itching, hearing loss and possible smelly discharge Left untreated, infection can travel deeper in to ear canalLeft untreated, infection can travel deeper in to ear canal Refer to physicianRefer to physician Prevent with proper drying after swimming or with ear plugsPrevent with proper drying after swimming or with ear plugs

Nose InjuriesNose Injuries

Epitaxis (Nosebleed)Epitaxis (Nosebleed)

Can be caused by Can be caused by direct blow or direct blow or constant blowing of constant blowing of the nose during a coldthe nose during a cold

Some more prone to Some more prone to nosebleed, some nosebleed, some medications can medications can make one more make one more susceptiblesusceptible

Epitaxis (Nosebleed)Epitaxis (Nosebleed) Have athlete lean Have athlete lean

forward and pinch noseforward and pinch nose Apply ice and pack with Apply ice and pack with

gauze to help control gauze to help control bleedingbleeding

DO NOT have athlete tilt DO NOT have athlete tilt head back, causes blood head back, causes blood to drain into throat and to drain into throat and obstructs airwayobstructs airway

Discourage nose Discourage nose blowing, causes nose to blowing, causes nose to bleed againbleed again

If bleeding is excessive If bleeding is excessive or does not stop ,treat or does not stop ,treat for shock and send to for shock and send to hospitalhospital

Deviated septumDeviated septum

Cartilage that Cartilage that separates the right separates the right and left sides of nose and left sides of nose has moved to one has moved to one side causing side causing decreased airflowdecreased airflow

Usually caused by Usually caused by direct blowdirect blow

Deviated septumDeviated septum Usually causes Usually causes

nosebleed, control nosebleed, control this firstthis first

Test by unilaterally Test by unilaterally blocking each nostril blocking each nostril and forcing air outand forcing air out

If deviated, may also If deviated, may also be brokenbe broken

Refer to see if Refer to see if surgery is neededsurgery is needed

Nasal fractureNasal fracture Usually caused by direct Usually caused by direct

blowblow Severe bleeding Severe bleeding

commoncommon Treatment same as Treatment same as

nosebleed to beginnosebleed to begin Athlete may have heard Athlete may have heard

a snapa snap May be painful or difficult May be painful or difficult

to breatheto breathe May have crepitus on May have crepitus on

palpationpalpation Not always deformityNot always deformity Refer for surgical Refer for surgical

recommmendationrecommmendation

Mouth InjuriesMouth Injuries

Maxilla fractureMaxilla fracture

Most often caused by Most often caused by direct blowdirect blow

Pain with movement Pain with movement and swelling and swelling commoncommon

Prevent extensive Prevent extensive movement and refermovement and refer

Fractured mandibleFractured mandible

Most often caused by Most often caused by direct blowdirect blow

Pain with movement and Pain with movement and swelling commonswelling common

May see a space May see a space between teeth not between teeth not previously therepreviously there

Teeth may not alignTeeth may not align Discoloration under Discoloration under

tonguetongue

Fractured mandibleFractured mandible

Apply ice as toleratedApply ice as tolerated Prevent extensive movement and refer Prevent extensive movement and refer

immediatelyimmediately Physician will realign and wire the mouth Physician will realign and wire the mouth

shutshut 4-6 weeks of feeding through a straw4-6 weeks of feeding through a straw Return to activity decided by physicianReturn to activity decided by physician

Temporomandibular Temporomandibular DislocationDislocation

Caused by a blow to Caused by a blow to the chin or forced the chin or forced opening of the mouthopening of the mouth

Jaw usually locks Jaw usually locks open due to muscle open due to muscle spasmspasm

Extremely painfulExtremely painful Refer immediately for Refer immediately for

relocationrelocation

Tooth dislocationTooth dislocation

Caused by direct impactCaused by direct impact Severe pain, bleeding, Severe pain, bleeding,

swellingswelling Using gloves, pick up Using gloves, pick up

tooth, with sterile gauze tooth, with sterile gauze pad, must be kept moistpad, must be kept moist

Keep in saline tooth kit Keep in saline tooth kit or glass of milkor glass of milk

Refer to dentist Refer to dentist immediatelyimmediately

Keep gauze in mouth in Keep gauze in mouth in place of toothplace of tooth

Fractured toothFractured tooth Caused by direct Caused by direct

impactimpact Pain and difficulty Pain and difficulty

closing mouthclosing mouth Keep fractured Keep fractured

portion of tooth if portion of tooth if found, send to found, send to dentist with athletedentist with athlete

Cannot put it back, Cannot put it back, but may be helpful in but may be helpful in reconstruction of reconstruction of toothtooth