Facial Injuries in Sport

Question 1

What are you trying to achieve with your management of soft tissue injuries?

Answer 1

Optimal healing with minimal aesthetic or functional deficit
Avoid worsening situation
Repair of damaged tissue
Minimal scarring

Question 2

Management of epistaxis ?

Answer 2

Insert a dental cotton roll – pre-soaked in dental anaesthetic into each nostril and then keep pressure applied. Keep the head forward as this allows blood to run forwards and out through the nose or mouth.

Question 3

What is the quick examination order for face injuries ?

Answer 3

Facial symmetry and sensation - Fracture
Bruising of lesions
Eye movements and bleeding.
Nose deformainty & airflow
Ear cuts or drum damage.
Mouth, tongue or teeth damage.
Jaw segments stability

Question 4

Signs of inferior orbital wall fracture

Answer 4

Peri-orbital ecchymosis/bruising – lids or around the orbital frame
Subconjunctival haemorrhage – bleeding over the sclera – suspect a base of skull fracture or a direct blow to the eye
Lowering of the level of the pupil
Enophthalmos
Diplopia and reduced eye movements

Question 5

diplopia?

Answer 5

Interference with the action required to maintain co-ordination of eye movements

Question 6

Signs of medial orbital wall fracture

Answer 6

Epistaxis
Surgical emphysema
Enophthalmos - sunken eyes
Horizontal diplopia

Question 7

Specific signs which must alert the practitioner to the possibility of retrobulbar haemorrhage

Answer 7

Proptosis - the eye is pushed forwards and gentle palpation of the eye through the eyelid, reveals a tense structure not the normal soft eyeball
Ophthalmoplegia (inability to move the eye)
Severe pain, out of proportion to the injury
Reduced visual acuity

Question 8

Signs and symptoms of zygomatic fractures - Larral eye bridge

Answer 8

Peri-orbital ecchymosis/haematoma/bruising
Epistaxis
Subconjunctival haemorrhage
Diplopia
En/Exophthalmos
Infra-orbital anaesthesia or paraesthesia
Deformity
Restricted mandibular movements (if the TMJ is restricted under a fractured zygomatic arch)
Subcutaneous emphysema

Question 9

Assessment of a middle third facial fracture (le Fort)

Answer 9

Hold the nasal bones with the thumb and index finger of one hand and the upper jaw/maxilla with the thumb and index finger of the other (finger on the palatal side and thumb on the buccal side of the front teeth area. Attempt to gently move the hand holding the upper jaw/maxilla over the anterior teeth area, back and forward (anterior/posterior), remove any mouthguard or denture first. If the hand holding the upper jaw/maxilla moves then the upper jaw is broken and this is a Le Fort/middle third facial fracture.

Question 10

Signs and Symptoms of Mandibular Fracture

Answer 10

Inspection
Step deformity of the occlusion or on external palpation of the mandible
Loss of normal mandibular arch form
Dental malocclusion/abnormal bite, if bilateral may be an Anterior Open Bite
Sublingual haematoma (look under the tongue)
Bleeding or tear in gingivae/gum
Missing or loose teeth

Palpation
Mobility of segments
Step defects in buccal or lingual sulci