head and face 2003
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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.