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Facial Injuries

Facial Injuries. Soft Tissue Injury Abrasions, Contusions, Lacerations, Avulsions Lots of bleeding - Why? Clean and cover - Why? Epistaxis - Nosebleed DON’T BLOW NOSE - REMOVES CLOT Bony Injury Nasal Bone Fracture - most common Nasal Septum Fracture - Cartilage and bone

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Facial Injuries

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  1. Facial Injuries • Soft Tissue Injury • Abrasions, Contusions, Lacerations, Avulsions • Lots of bleeding - Why? • Clean and cover - Why? • Epistaxis - Nosebleed • DON’T BLOW NOSE - REMOVES CLOT • Bony Injury • Nasal Bone Fracture - most common • Nasal Septum Fracture - Cartilage and bone • More serious - hematoma may develop • Tx: Ice, nose packing, refer

  2. Facial Injuries • Bony Injuries - MOI: direct blows • Mandible(Jaw) Fracture - 2nd most common • Malocclusion of teeth, bleeding around teeth, lower lip numbness • Ice, immobilize, Dr. • Mandible Dislocation - TMJ joint • Locked open, extreme malocclusion • DON’T REDUCE, ice, immobilize, Dr. • Zygomatic Fracture - 3rd most common • Deformity, epistaxis, vision problems(diplopia) • Maxillary Fracture - 4th most common • Malocclusion, deformity, vision problems, epistaxis • LeFort Fractures

  3. Eye Anatomy • Anatomy • sit in orbit(bony) protection • eyelid • lacrimal glands • sclera - tough white outer layer • cornea, iris, lens • pupil

  4. Eye injuries • Injuries • Can be very serious, must be evaluated and referred to opthamologist if necessary. • Orbital Hematoma (black eye) • Foreign Body • Pain and disability, tearing • DON’T RUB IT OUT - Why? • Corneal Abrasion • Pain, tears, blurred vision • Patch, Dr., Flourescein Strips (Blue light) • 1-2 days to heal

  5. Corneal abrasion

  6. Conjunctivitis Iritis • Traumatic iritis/Chronic iritis • Inflammed conjunctiva next to cornea over iris, photophobia, slow reaction • Conjunctivitis • Viral (“pink eye”) or bacterial (yellow/green) • Itchy, burning, reddening, discharge, eyelid swelling, blurry, sticky eyes • Stye – DO NOT SQUEEZE • bacterial infection that occurs inside an oil gland near the base of your eyelid. Stye

  7. Eye Injuries • Hyphema • Blood in eye, vision block(full or partial) • Patch both eyes, NO ICE, Medical emergency • Blowout Fracture - orbit of eye is fractured • Hit on orbit, hit on eye(inc. pressure=blowout) • Discoloration inferior margins, Inability to move eye up, diplopia (double vision), pain • Retinal Detachment • Direct blow • Specks in vision, “flashes of light”, “curtain falling over vision” • Acute Trauma • Be aware of lacrimal gland lacerations and damage to other structures

  8. Pencil was in eye “tear drop” iris Blow out fracture

  9. Dental Injuries • Anatomy • Crown • Dentin • Pulp • Root • Enamel • Injuries • Teeth have lowest potential to return to a state of health following traumatic injury. • Role to athletic trainer - care for athlete and tooth and get athlete to dentist if necessary. • Do not touch root or tooth

  10. SAVE A TOOTH • SAVE A TOOTH - balanced solution - Transport Media • OR • Milk, Saline, Saliva, Water

  11. Dental Injuries • Tooth Displacement • Extrusion or Lateral Luxation • Can try to reposition, Dentist • Intrusion • Don’t try to reposition, mouth closed, Dentist • Fractured Tooth - crown or root • No return, Dentist, save tooth fragment • Tooth Avulsion • Handle tooth by crown only • Replace in socket if possible • Save tooth - keep moist at all times • Dentist - 1/2-2 hrs. • less than 30 mins. = 90% survival rate • greater than 2 hrs. = 5 % survival rate

  12. Ear Injuries • Anatomy • External Ear, Middle Ear, Internal Ear • Injuries • Swimmer’s Ear - External Otitis • Ear Infection – Otitis Medius • Hematoma Auris • MOI: extreme friction • S/S: swelling, hematoma • Tx: ice, compression, aspiration, collodian pack • Cauliflower Ear • Hardened tissue of untreated hematoma auris • Keloid tissue is resultant

  13. Prevention of Facial, Dental, Ear, and Eye Injuries • Protective Equipment • Helmets • Facemasks • Eye Protection • Mouthguard • Ear Protection

  14. H.O.P.S

  15. History • What is the major complaint? • What is mechanism of injury? • What is its duration? • Was the onset of the complaint gradual or sudden? • Is there any loss of vision, hearing, taste, smell? • Can they swallow and speak without difficulty? • Is there any pain? • Is the condition improving or getting worse? • Is there any history of trauma? • Is there any family history of a similar complaint?

  16. Observation • Inspect all facial areas • Be aware of alignment, bleeding, ecchymosis (ruptured blood vessels)

  17. Removing a foreign object

  18. Inspection/Palpation • Orbital margin • Frontal bone, Nasal bone, Zygomatic arch, Maxilla, Mandible • Temporomandibular joint (TMJ) • Teeth • Soft tissue – Nasal, Cheeks, Ear

  19. Functional or Special Tests • Vision Assessment • Snellen Chart • Myopia – nearsightedness • Hyperopia – farsightedness • Visual acuity – photophobia or diplopia • Anisocoria – condition of unequal pupils • Pupil Reaction to Light • Pen light • PEARL – pupils equal and reactive to light • Eye Motility • “follow my finger but do not move your head” • Nystagmus • Flourescein dye test (if available)

  20. Functional or Special Tests • Hearing and Balance • Smell • Jaw motion and Teeth alignment • Malocclusion (misalignment) • Open, Close, Side to Side, Protract • Palpation at TMJ – pinkies in ear • Dermatomes • Sensation

  21. When should I refer? • Visual field changes • Photophobia (light sensitivity) and/or Diplopia (double vision) • Cloudy vision • Nystagmus • Pain/Throbbing intense • Crepitus or Laceration • Deformity – bony or tooth • S/S of serious injury • Numbness • Hearing or Balance issues • Oozing pus or drainage of water

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