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Introduction

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I was trying to move it while it was still fresh. I know that once it sets it’s harder.

Steve Nash commenting on trying to align his nasal fracture during an NBA Western Conference Final Game

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Injuries to the face in sport usually result from direct trauma. After reviewing clinical assessment and soft tissue injury management, this chapter outlines management of injuries to the nose, ear, eye, teeth, and facial bones.

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Functional anatomy

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The bones of the face are shown in Figure 19.1. As most of these bones are subcutaneous, they are easily examined. Examination should include palpation of the forehead and supraorbital rims for irregularities and contour deformities.

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The orbit is a cone-shaped cavity formed by the union of seven cranial and facial bones. The orbital margin consists of the supraorbital ridge above, the infraorbital margin below, the zygomatic arch laterally, and the nasal bone medially. The recess formed protects the eye from a blow from a large object. A smaller, deformable object such as a squash ball may, nevertheless, compress the eyeball and cause a “blow-out” fracture of the orbit.

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The zygomatic arch of the malar bone creates the prominence of the cheek. Fractures in this region may cause flattening of the cheek and a palpable irregularity in the inferior orbital margin.

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The maxilla forms the upper jaw. Its superior surface helps create the floor of the orbit and the inferior surface forms the major part of the hard palate. Mobility of the hard palate, determined by grasping the central incisors, indicates a maxillary fracture.

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The lower jaw consists of the horseshoe-shaped mandible. The mandible is made up of body, angle, and ramus, which are easily palpated. The coronoid process can be palpated by a direct intraoral approach. The gingiva overlying the alveolar ridge may be lacerated in mandibular body fractures.

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Clinical assessment

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Facial injuries1 are frequently associated with profuse bleeding. While it is important to control the bleeding, it is also vital to fully assess the underlying structures. All head and neck injuries should be considered closed head injuries. Cervical spine precautions should be taken if the patient is unconscious or has neurological deficits or cervical spine tenderness. The airway is particularly vulnerable to obstruction because of bleeding, structural compromise of bony structures (e.g. mandible), or dislodged teeth, tooth fragments, or dental appliances. The practical steps to assess facial injuries are as follows:

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  • Ascertain the mechanism of injury and locate the source of the patient’s pain.

  • Check for blurred vision, diplopia, concussion, or cerebrospinal fluid leakage.

  • Inspect the nasal septum for hematomas and nasal obstruction.

  • Inspect the external ear for hematomas.

  • Observe facial asymmetry or ...

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