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