Anatomy of Head and FaceAnatomy of Head and Face
Bones of skullBones of skull CraniumCranium
Protects the brainProtects the brain FacialFacial
Provide the structure of the faceProvide the structure of the face Form the sinuses, orbits of the eyes, nasal cavity, and Form the sinuses, orbits of the eyes, nasal cavity, and
the mouththe mouth ScalpScalp
Protective function Protective function Extensive blood supplyExtensive blood supply
Anatomy of Head and Face Anatomy of Head and Face (cont.)(cont.)
BrainBrain Major regions Major regions
Cerebral hemispheresCerebral hemispheres DiencephalonDiencephalon BrainstemBrainstem Cerebellum Cerebellum
Anatomy of Head and Face Anatomy of Head and Face (cont.)(cont.)
Meninges Meninges Protective tissue that encloses brain Protective tissue that encloses brain
and spinal cordand spinal cord Dura mater; arachnoid mater; pia Dura mater; arachnoid mater; pia
mater mater
Anatomy of Head and Face Anatomy of Head and Face (cont.)(cont.)
EyesEyes ConjunctivaConjunctiva Lacrimal glandsLacrimal glands Tunics: sclera; choroid; retinaTunics: sclera; choroid; retina CorneaCornea
Anatomy of Head and Face Anatomy of Head and Face (cont.)(cont.)
NoseNose Composed of bone and hyaline Composed of bone and hyaline
cartilagecartilage Nasal septumNasal septum
Anatomy of Head and Face Anatomy of Head and Face (cont.)(cont.)
EarEar Major areasMajor areas
Outer ear (auricle and external Outer ear (auricle and external auditory canal)auditory canal)
Middle ear (tympanic membrane)Middle ear (tympanic membrane) Inner ear (labyrinth) Inner ear (labyrinth)
Anatomy of Head and Face Anatomy of Head and Face (cont.)(cont.)
NervesNerves Cranial nerves Cranial nerves
Motor functions, Motor functions, sensory functions, or sensory functions, or bothboth
Numbered and Numbered and named in named in accordance with accordance with their functions their functions
Blood vesselsBlood vessels Common carotidCommon carotid VertebralVertebral
Prevention of Head and Facial Prevention of Head and Facial InjuriesInjuries
Protective equipmentProtective equipment HelmetsHelmets Face guardsFace guards Mouth guardsMouth guards Eye wearEye wear Ear wearEar wear Throat protectorsThroat protectors
Scalp InjuriesScalp Injuries
Highly vascularized; bleeds freelyHighly vascularized; bleeds freely LacerationLaceration
Control bleedingControl bleeding Prevent contaminationPrevent contamination Assess for skull fracture (fx)Assess for skull fracture (fx) Management: Management:
If no fx, cleanse, cover, and referIf no fx, cleanse, cover, and refer Abrasions and contusionsAbrasions and contusions
Cleanse; ice and pressureCleanse; ice and pressure 24 hours: no improvement – refer24 hours: no improvement – refer
Cranial Injury MechanismsCranial Injury Mechanisms
Injury dependent on:Injury dependent on: Material properties of skullMaterial properties of skull Thickness of skullThickness of skull Magnitude and direction Magnitude and direction
of forceof force Size of impact areaSize of impact area
Bone deforms and Bone deforms and bends inwardbends inward Inner border – tensile Inner border – tensile
strainstrain Outer border – Outer border –
compressedcompressed
Cranial Injury Mechanisms Cranial Injury Mechanisms (cont.)(cont.)
Brain Brain accelerationacceleration Shear, tensile, Shear, tensile,
and compression and compression strains within strains within brain brain
Contrecoup Contrecoup injuryinjury
Cranial Injury Mechanisms Cranial Injury Mechanisms (cont.)(cont.)
Focal injuryFocal injury Localized damageLocalized damage Epidural, subdural, or intracerebral hematomas Epidural, subdural, or intracerebral hematomas
Diffuse injuryDiffuse injury Widespread disruption Widespread disruption ConcussionConcussion
Accurate assessment of head injury is Accurate assessment of head injury is essential essential
Conscious, ambulatory individual should not Conscious, ambulatory individual should not be considered to have only a minor injurybe considered to have only a minor injury
Skull FractureSkull Fracture
TypesTypes Linear Linear Comminuted Comminuted Depressed Depressed BasilarBasilar
Skull Fracture (cont.)Skull Fracture (cont.)
Potential for varying signs and Potential for varying signs and symptoms (S&S)symptoms (S&S) Visible deformity–do not be misled by a Visible deformity–do not be misled by a ““goose egggoose egg””; a fracture may be under the ; a fracture may be under the sitesite
Deep laceration or severe bruise to scalpDeep laceration or severe bruise to scalp Palpable depression or crepitusPalpable depression or crepitus Unequal pupilsUnequal pupils Raccoon eyes or BattleRaccoon eyes or Battle’’s signs sign
Skull Fracture (cont.)Skull Fracture (cont.)
Bleeding or CSF from nose and/or earBleeding or CSF from nose and/or ear Loss of smellLoss of smell Loss of sight or major vision Loss of sight or major vision
disturbancesdisturbances Unconsciousness Unconsciousness 2 minutes after direct 2 minutes after direct
trauma to the headtrauma to the head Management: activation of EMSManagement: activation of EMS
Facial ConditionsFacial Conditions
Facial soft tissue conditionsFacial soft tissue conditions Contusions, abrasions, and lacerations Contusions, abrasions, and lacerations
are managed the same as elsewhere are managed the same as elsewhere on the body on the body
Complicated injuries—immediate Complicated injuries—immediate physician referralphysician referral
Facial Conditions (cont.)Facial Conditions (cont.)
Temporomandibular joint conditionsTemporomandibular joint conditions S&SS&S
Inability to open and/or close mouth (dislocation Inability to open and/or close mouth (dislocation and meniscus displacement) and meniscus displacement)
MalocclusionMalocclusion Joint crepitus with opening and closing Joint crepitus with opening and closing Pain with opening and biting Pain with opening and biting Deviation of the mandible on opening (toward Deviation of the mandible on opening (toward
side of injury)side of injury)
Facial Conditions (cont.)Facial Conditions (cont.)
FracturesFractures Zygomatic Zygomatic
S&S: cheek appears flat or depressed, double vision, S&S: cheek appears flat or depressed, double vision, numbness in affected cheeknumbness in affected cheek
Management: ice, immediate referralManagement: ice, immediate referral MandibularMandibular
Common: mandibular angle and condylesCommon: mandibular angle and condyles S&S: malocclusion, changes in speech, oral bleeding, S&S: malocclusion, changes in speech, oral bleeding,
+ tongue blade+ tongue blade Management: ice, immediate referralManagement: ice, immediate referral
Facial Conditions (cont.)Facial Conditions (cont.)
FracturesFractures Maxillary Maxillary
LeFort fx (upper jaw)LeFort fx (upper jaw) S&S: appearance of longer face, nasal bleeding, S&S: appearance of longer face, nasal bleeding,
malocclusion, nasal deformity, ecchymosismalocclusion, nasal deformity, ecchymosis Management: ice, immediate referralManagement: ice, immediate referral
Facial Facial ““red flagsred flags””
Nasal ConditionsNasal Conditions
EpistaxisEpistaxis Anterior – bleeding from anterior septumAnterior – bleeding from anterior septum
Posterior – bleeding from lateral wallPosterior – bleeding from lateral wall Management: ice, mild pressure, slight forward Management: ice, mild pressure, slight forward
head tilt; nasal plug; head tilt; nasal plug; 5 minutes – physician referral5 minutes – physician referral Deviated septumDeviated septum
S&SS&S Consistent difference in airflow between the 2 sides of the Consistent difference in airflow between the 2 sides of the
nose when one nostril is blockednose when one nostril is blocked Confirm using otoscope Confirm using otoscope
Management: physician referralManagement: physician referral
Nasal Conditions (cont.)Nasal Conditions (cont.)
FracturesFractures Most common: lateral displacementMost common: lateral displacement Range of severity variesRange of severity varies S&SS&S
Asymmetry – especially with lateral forceAsymmetry – especially with lateral force EpistaxisEpistaxis CrepitusCrepitus
Management: control bleeding; referManagement: control bleeding; refer Nasal Nasal ““red flagsred flags””
Oral and Dental ConditionsOral and Dental Conditions
Periodontal diseasePeriodontal disease S&S of gingivitis S&S of gingivitis
Tender, swollen, or bleeding gumsTender, swollen, or bleeding gums Change in the gums' color from pink to Change in the gums' color from pink to
dusky reddusky red Plaque and bacteria that cover the teeth Plaque and bacteria that cover the teeth
not readily visiblenot readily visible
Oral and Dental Conditions Oral and Dental Conditions (cont.)(cont.)
S&S of periodontitis S&S of periodontitis Swollen or recessed gumsSwollen or recessed gums Unpleasant taste in the mouthUnpleasant taste in the mouth Bad breathBad breath Tooth painTooth pain Drainage or pus around one or more teeth Drainage or pus around one or more teeth
Management: referral to dentistManagement: referral to dentist
Oral and Dental Conditions Oral and Dental Conditions (cont.)(cont.)
Dental caries (tooth decay)Dental caries (tooth decay) Primarily caused by plaque...dissolves the tooth Primarily caused by plaque...dissolves the tooth
enamel…allows bacteria to infect the center of the enamel…allows bacteria to infect the center of the tooth tooth
S&SS&S Pain during chewing Pain during chewing Sensitivity to hot/cold foods and beveragesSensitivity to hot/cold foods and beverages If tooth abscess is present:If tooth abscess is present:
Throbbing painThrobbing pain Sharp or shooting painSharp or shooting pain
Management: refer to dentistManagement: refer to dentist
Oral and Dental Conditions Oral and Dental Conditions (cont.)(cont.)
Mouth lacerationsMouth lacerations Minor lacerations are the same as in other lacerations Minor lacerations are the same as in other lacerations Lip and tongue lacerations: require special suturingLip and tongue lacerations: require special suturing
Loose teethLoose teeth Displaced outward or lateral: attempt to place back in Displaced outward or lateral: attempt to place back in
normal positionnormal position Intruded: immediate referral to dentistIntruded: immediate referral to dentist
Oral and Dental Conditions Oral and Dental Conditions (cont.)(cont.)
Fractured toothFractured tooth Enamel: no symptomsEnamel: no symptoms Dentin: pain and increased sensitivity to Dentin: pain and increased sensitivity to
heat and coldheat and cold Pulp or root: severe pain and sensitivityPulp or root: severe pain and sensitivity Management: refer to dentistManagement: refer to dentist
Oral and Dental Conditions Oral and Dental Conditions (cont.)(cont.)
Dislocated toothDislocated tooth Time is of the essence; referTime is of the essence; refer Hold tooth by crownHold tooth by crown Do not rub the tooth or remove any Do not rub the tooth or remove any
dirt; milk or salinedirt; milk or saline Oral and dental Oral and dental ““red flagsred flags””
Ear ConditionsEar Conditions
Cauliflower ear (auricular hematoma)Cauliflower ear (auricular hematoma) Repeated trauma pulls cartilage away from Repeated trauma pulls cartilage away from
perichondrium – hematoma formsperichondrium – hematoma forms Untreated – forms a fibrosisUntreated – forms a fibrosis Management: ice; possible aspiration by Management: ice; possible aspiration by
physicianphysician Key is prevention!Key is prevention!
Impacted cerumen (wax)Impacted cerumen (wax) Possible hearing loss or muffled hearing Possible hearing loss or muffled hearing Management: irrigate canal with warm water Management: irrigate canal with warm water
Ear Conditions (cont.)Ear Conditions (cont.)
Otitis externa (swimmerOtitis externa (swimmer’’s ear)s ear) Bacterial infection to lining of external auditory canalBacterial infection to lining of external auditory canal S&S: pain, itchingS&S: pain, itching Management: ear drops, custom ear plugsManagement: ear drops, custom ear plugs
Otitis mediaOtitis media Middle ear infection due to bacteria or virusMiddle ear infection due to bacteria or virus S&S: earache, hearing difficulty, possible serous S&S: earache, hearing difficulty, possible serous
otitisotitis Management: physician referralManagement: physician referral
Ear Conditions (cont.)Ear Conditions (cont.)
Tympanic membrane ruptureTympanic membrane rupture Caused by:Caused by:
Infection Infection Direct trauma Direct trauma Changes in pressure Changes in pressure Loud, sudden noises Loud, sudden noises Foreign objects in the earForeign objects in the ear
Ear Conditions (cont.)Ear Conditions (cont.)
S&SS&S Very painfulVery painful TinnitusTinnitus Pus-filled or bloody drainage from the earPus-filled or bloody drainage from the ear Sudden decrease in ear pain followed by Sudden decrease in ear pain followed by
drainagedrainage Hearing loss Hearing loss
Management: physician referralManagement: physician referral Ear Ear ““red flagsred flags””
Eye ConditionsEye Conditions
Preorbital ecchymosis (black eye)Preorbital ecchymosis (black eye) AssessmentAssessment Management: ice, referral to Management: ice, referral to
ophthalmologist ophthalmologist Foreign bodiesForeign bodies
S&S: intense pain, tearingS&S: intense pain, tearing ManagementManagement
Not embedded: removal, inspectionNot embedded: removal, inspection Embedded: do not touch, activate EMSEmbedded: do not touch, activate EMS
Eye Conditions (cont.)Eye Conditions (cont.)
StySty Infection of sebaceous gland of Infection of sebaceous gland of
eyelash eyelash Starts as a red nodule; progresses into Starts as a red nodule; progresses into
a painful pustule a painful pustule Management: moist heat compressManagement: moist heat compress
Eye Conditions (cont.)Eye Conditions (cont.)
Conjunctivitis (pink eye)Conjunctivitis (pink eye) S&S: itching, burning, watering, red S&S: itching, burning, watering, red
appearanceappearance Management: infectious; refer to physicianManagement: infectious; refer to physician
Corneal abrasionCorneal abrasion S&S: pain, tearing, photophobia, irritated with S&S: pain, tearing, photophobia, irritated with
blinking and eye movement, feeling of blinking and eye movement, feeling of ““something in the eyesomething in the eye””
Management: drops and eye patchManagement: drops and eye patch
Eye Conditions (cont.)Eye Conditions (cont.)
Corneal lacerationCorneal laceration S&S: severe pain, decreased visual S&S: severe pain, decreased visual
acuityacuity Management: cover with no pressure, Management: cover with no pressure,
activate EMS, transport supine or activate EMS, transport supine or uprightupright
Eye Conditions (cont.)Eye Conditions (cont.)
Subconjunctival Subconjunctival hemorrhagehemorrhage Rupture of small Rupture of small
capillaries; sclera capillaries; sclera appears red, blotchy, appears red, blotchy, inflamedinflamed
Requires no treatmentRequires no treatment Hyphema Hyphema
Caused by blunt traumaCaused by blunt trauma Hemorrhage into Hemorrhage into
anterior chamberanterior chamber Management: activation Management: activation
of EMSof EMS
Eye Conditions (cont.)Eye Conditions (cont.)
Detached retinaDetached retina Can occur with or without traumaCan occur with or without trauma S&S: floaters and light flashesS&S: floaters and light flashes Management: patch both eyes; Management: patch both eyes;
refer to ophthalmologist refer to ophthalmologist
Eye Conditions (cont.)Eye Conditions (cont.)
Orbital Orbital ““blowoutblowout”” fracture fracture Impact from a blunt object, usually larger than Impact from a blunt object, usually larger than
the eye orbit the eye orbit S&S:S&S:
DiplopiaDiplopia Numbness below eyeNumbness below eye Lack of eye movementLack of eye movement Recessed downward displacement of globeRecessed downward displacement of globe
Management: ice; immediate referral to Management: ice; immediate referral to physicianphysician
Eye Eye ““red flagsred flags””