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Head and FaceHead and Face

Laura ThurmondLaura Thurmond Amy WalkerAmy Walker

Ross BaileyRoss Bailey

Dr. JoeDr. Joe MilneMilne

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Facial, Eye and DentalFacial, Eye and Dental

TraumaTrauma

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Cranial VaultCranial Vault

One frontalOne frontal Two sphenoidTwo sphenoid

Two parietalTwo parietal

One occipitalOne occipital

Also called theAlso called theskullskull

Strongest skullStrongest skullbone is thebone is the

occipital and theoccipital and theweakest is theweakest is thetemporaltemporal

The skull reachesThe skull reaches90% of its ultimate90% of its ultimatesize by age 5size by age 5

*Magee,67*Magee,67

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Facial BonesFacial Bones

14 total facial14 total facialbonesbones

Most importantMost important::

MaxillaMaxilla

MandibleMandible

Nasal BonesNasal Bones

PalatinePalatine

LacrimalLacrimal

ZygomaticZygomatic

EthmoidEthmoid

60% of the60% of theUltimate size isUltimate size is

reached by agereached by age

66 Zygomatic boneZygomatic bone

provides for theprovides for the

prominence ofprominence ofthe cheekthe cheek

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Cranial Vault and Facial Bones

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Posterior View of the Cranial Vault

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Facial Skull Cavities andFacial Skull Cavities and

SinusesSinuses

CavitiesCavitiesOrbitalOrbital

NasalNasal

OralOral

SinusesSinusesFrontalFrontal

EthmoidEthmoid

MaxillaryMaxillary

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Cranial NervesCranial Nerves OlfactoryOlfactory: smell: smell

OpticOptic: sight: sight

OculomotorOculomotor: eye muscles: eye muscles

TrochlearTrochlear: eye muscles: eye muscles

TrigeminalTrigeminal: facial sensation: facial sensation

AbducensAbducens: eye muscles: eye muscles FacialFacial: facial movement: facial movement

VestibulocochlearVestibulocochlear::

equilibrium and hearingequilibrium and hearing

GlossopharyngealGlossopharyngeal: throat: throatmovement and sensationmovement and sensation

VagusVagus: pharyngeal muscles: pharyngeal muscles

AccessoryAccessory: turns head right: turns head right

and leftand left

HypoglossalHypoglossal: tongue: tongue

movementmovement

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Cranial Vault and FacialCranial Vault and Facial

MusclesMuscles

Cranial VaultCranial VaultFrontalisFrontalis

TemporalisTemporalis

OccipitalisOccipitalis

FacialFacialOrbicularis OculiOrbicularis Oculi

Orbicularis OrisOrbicularis Oris

Zygomaticus MajorZygomaticus Majorand Minorand Minor

MassterMasster

Depressor Anguli OrisDepressor Anguli OrisBuccinatorBuccinator

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Anterior View: Cranial vault and

Facial Muscles

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Lateral View: Cranial Vault and

Facial Muscles

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Eye AnatomyEye Anatomy

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Eyes

Our most important sensory organ

Foreign bodies in the eye

1. Non penetrating

May be washed out naturally with the tearduct system, however, the upper lid may

need to be reversed and then the eye must

be Irrigated with sterile saline.

The cornea or conjunctiva may become

abraded or cut as a result of a foreign bodyrubbing between the lid and the eye itself.

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This type of wound is examined best under a uv

light with The surface of the eye stained with aFluor-I-Strip

[ sodium Fluorescein ]. This will indicate the

location and size of the Abrasions] is present. The

eye should be patched using a moist Sterile eye

patch and treated with optic antibiotics.

[ physician Required ].

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Penetrating eye injuries

Never attempt to remove an objectthat has penetrated the surface of

the cornea or conjunctiva andespecially any object that has

penetrated into the lens or posteriorchamber of the eye [ vitreous ]

This should be treated by coveringboth eyes and transporting.

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Contusions

Levator palpebrae contusionThis muscle elevates the upper lid

and can be contused when pokedor jabbed by a finger. Patching of

the eye and treating like a soft

tissue injury will usually result ingood results with 2-3 days.

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Contusion of eye - patient was wearing glasses

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Black Eye with associated laceration

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Subconjunctival hematoma

While this condition is often verynoticeable, it is a condition that does

not require any care. It is caused by arupture of one of the smallsuperficial blood vessels.

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Hyphemia - anterior chamber

contusion

This results from blunt trauma such as getting hit with aball or being stuck in the eye with a finger

Blood collects between the lens and the cornea. Visual

acuity may be reduced. This is a condition that can

become serious, and an ophthalmologist should always

be consulted. A secondary finding often associated with

this involves hypoglacoma in which the pressure in the

eye is reduced and this can lead to disruption of theretina. Treatment involves bed rest.

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Hemorrhage into the posterior

chamber

If there is considerable bleeding into the

globe, the eye may be tinted red with the

red reflex lost. This is when the eye showsas red when examined with a light. This is

a serious injury and should be referred

quickly.

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Hyphema Blood in the Anterior Chamber

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Detached retina

The patient will report sights such as a

curtain fell over part of my eye and of

floaters, objects that come and go into thefield of vision. This condition should bereferred.

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Retinal Detachment

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Chemical burns to the eye

The only treatment that can be done is to wash

the eye and dilute the chemical. The patient

should then be referred to the ER and orphysician.It is important to know thatchemicals got into the eye. (product labels)

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31,000 Eye Injuries in sport each year.

TABLE 1. 1998 Sports and Recreational Eye Injury Estimates by Age-Group and Percentage of Total

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All Ages Under 5 Ages 5-14 Ages 15-24 Ages 25-64 65 and Older

Activity Est (%) Est (%) Est (%) Est (%) Est (%) Est (%)

Basketball 8,723 (22.2) 148 (0.4) 2,338 (5.9) 3,856 (9.8) 2,381 (6.1) 0 (0)

Water/pool sports 4,593 (11.7) 133 (0.3) 1,782 (4.5) 699 (1.8) 1,817 (4.6) 162 (0.4)

Baseball 4,029 (10.3) 182 (0.5) 2,195 (5.6) 823 (2.1) 829 2.1) 0 (0)

Racket sports* 2,767 (7.0) - (0) 1,000 (2.5) 926 (2.4) 822 (2.1) 19 (0)

Hockey** 1,614 (4.1) - (0) 515 (1.3) 628 (1.6) 471 (1.2) 0 (0)

Football 1,464 (3.7) - (0) 533 (1.4) 583 (1.5) 348 (0.9) 0 (0)

Soccer 1,325 (3.4) - (0) 741 (1.9) 378 (1.0) 206 0.5) 0 (0)

Ball sports*** 1,270 (3.2) 115 (0.3) 581 (1.5) 375 (1.0) 160 (1.0) 39 (0.1)

Golf 828 (2.1) 7 (0) 142 (0.4) 75 (0.2) 604 (1.5) 0 (0)

Combatives**** 448 (1.1) - (0) 56 (0.1) 82 (0.2) 310 (0.8) 0 (0)

Total selected sports 27,061 (68.9) 585 (1.5) 9,883 (25.1) 8,425 (21.4) 7,948 (20.2) 220 (0.6)

Other activities 12,236 (31.1) 596 (1.5) 4,273 (10.9) 2,932 (7.5) 4,190 (10.7) 245 (0.6)

Totals 39,297 (100.0) 1,181 (3.0) 14,156 (36.0) 11,357 (28.9) 12,138 (30.9) 465 (1.2)

*Includes racquetball, tennis, squash, paddleball, badminton, and handball

**Includes ice, field, street, and roller hockey

***Includes unspecified ball sports

****Includes boxing, martial arts, and wrestling

High Risk Sports for Eye Injury

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High Risk Sports for Eye Injury

Small, fast projectiles

Air rifle/BB gunPaintball

Hard projectiles, fingers, "sticks," close contact

Baseball/softball/cricketBasketball

Fencing

Field hockey

Ice hockeyLacrosse, men's and women's

Squash/racquetball

Street hockey

Intentional injury

Boxing

Full-contact martial arts

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Moderate Risk

Fishing

Football

Soccer/volleyballTennis/badminton

Water polo

Low Risk

Bicycling

Noncontact martial arts

Skiing

Swimming/diving/water skiing

Wrestling

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http://www.physsportsmed.com/issues/2000/06_00/vinger.htm

Physician and Sports Medicine magazine article on

Facial Injuries.

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Nasal fractures

Very little is done acutely

Ear, Nose, and Throat Physicians usually want the patient after some

of the swelling has subsided.

Acute cases can be splinted using a thermo plastic and moleskin or a

foam rubber. Full face protection is available from most orthotists.

Epistaxis or nasal bleeding should be controlled with ice and the useof a nasal vasoconstrictor such as Neo Synephrine or Afrin.

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Jaw Fractures

Maxilla fractures

These may involve separation of thepalate and or may extend into the nasalregion.

Types of Jaw Fractures

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Types of Jaw Fractures

Body 30%

Angle 25%

Condyle 15%

Symphysis 7%

Ramus 3%

Alvcolar 2%

Coronoid 1%

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The most common symptom other than

pain is that of malocclusion. This is wherethe teeth do not line up correctly due to the

loss of structural integrity of the lower jaw.Bleeding in the mouth may be found, facial

distortion and pain with palpation or biting.Fixation usually requires a wiring of the

teeth together for splinting any mayrequire an external bone plate to be

installed by the Oral Surgeon.

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Disrupted Root on left, Malocclusion on the right.

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Facial Fractures

Zygomatic Arch Fractures

This is a common facial bone to fracture when

hit in the face with a thrown ball or if two

athletes collide heads during practice orcompetition.

If the orbital floor of the eye socket is disrupted,then the eye on the effected side may droop

down or have difficulty in moving due to the

inferior muscles being trapped in the fracturesite.

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These fractures are commonly repaired by theENT Physician using an oral route and the

athletes may return to play in 4 to 6 weeks

with some protection for the next 3 to 4

months.

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Orbital blowout fractures

There is often an implosion of

the orbital contents by the

trauma and the regions of least

structural integrity will give outand that tends to be the orbital

floor and the medial orbital wall

as these soft tissues try to find aplace to go when the trauma is

impacted. This is the typical

appearance of a blowout fracture

into the maxillary sinus with a

trapdoor sort of appearance.

http://www.vh.org/adult/provider/radiology/IROCH/FacialTrauma/Captions/image15B.html

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This 35 year old man was injured riding his motorcycle by a plumbing pipe sticking out from a truckthat backed out of a driveway in front of him. He was going about 35 mph and unable to stop. The

pipe struck him in the face, crushing the cheek and floor of the eye socket.

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Dental Injuries

Lacerations in the mouth - clean

with a mixture of hydrogen peroxide

and water, suture if necessary.

Loose teeth

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Loose teeth

A tooth may become loose (partial displacement),intruded, extruded, or avulsed.

This injury needs to be treated by a dentist so thatthe tooth may be possibly saved.

Fractures of the tooth may extend into the enamel,dentin, pulp, or root. Those that extend into the

enamel cause no symptoms and can be smoothed

by the DDS. Fractures involving the dentin causepain and increased sensitivity to hot and cold

items. Fractures exposing the pulp (nerve area)

lead to serve pain and sensitivity.

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Dislocated tooth

Do not touch the root. It is very

sensitive. Rinse with normal, sterilesaline if dirty and attempt to replace the

tooth in the socket. If implantation bythe allied medical personnel is not

successful, then the tooth may be placed

either under the tongue or in a

commercially available "Save a Tooth

Kit".

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What can you the ATC do for dental

pain or mouth injuries?

Dental kit - sponges, Cavit, temp bond.

DO NOT use super glue !!

Oil of Cloves

Viscous Xylocaine for pain.