Jeffrey S. Fichera MS PAC

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Jeffrey S. Fichera MS PA-C

• The Ear, Nose, Throat and Plastic Surgery Assoc.
  Inc.

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Facial Injuries in Sports

• The Athletic Trainer must be prepaired to manage
  facial injuries, including
• Contusions
• Abrasions
• Laserations
• Nasal fractures

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Facial Injuries in Sports

• Septal hematomas
• Auricular hematoms
• Ruptured tympanic membranes
• Fractures of the facial bones

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Sports Acitivies

• Account for 3 to 29 of all facial injuries
• Approx. 10 to 42 of all facial fractures
• 60 to 90 of injures occur in male participants
  between 10 and 29 years old.

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Mechanism of Injury

• Direct Impact with another players body part
  (eg, head, fist, elbow)
• Equipment (eg, ball, puck, goalpost, handlebars )
• The Ground ( eg, wrestling mat, gym floor)
• Enviroment ( eg, tree, outfield wall )

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Return-to-Play

• Treament requires knowledge of the injury
• Type and serverity of injury
• Physicial demands of the sport

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Initial Exam and Evaluation

• Pertinent History
• Physicial Exam
• Remember the WOW FACTOR

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Soft-Tissue Injuries

• Contusions
• Abrasions
• Lacerations

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Contusions

• Most commonly encountered facial injury
• Results from blunt trauma to the face
• Treatment aimed at minimizing inflammatory
  response ( ice, nonsteroidals)

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Abraisions

• Partial-thickness disruptions of the epidermas
• Commonly results from blunt trauma or sudden
  forcible friction
• Always consider underlying injury
• 40 of all Tetanus (1998-2000) resulted from
  abrasions and lacerations

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Nasal Injuries

• Epistaxis
• Septal Hematoma
• Fracture

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Epistaxis

• 80 of all nose bleeds are from the anterior
  source ( ie. Kiesselbachs Plexus )
• 20 are posterior and usually a disease of the
  middle aged and elderly

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Nasal Blood Supply

• Why the WOW FACTOR?
• External Carotid
• Facial artery ( 2 branchs ant. Septum, ala )
• Internal maxillary ( most important )
• Terminal branch of EC gives rise to
• Sphenopalatine
• Nasopaltine
• Greater palatine

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Nasal Blood Supply

• Internal Carotid
• Opthalmic artery
• Anterior and Posterior ethmoid artery

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Nasal Blood Supply
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EPISTAXIS

• Cosider nasal fracture as source of epistaxis.
• Athlete may report having heard a crunch or
  crack.
• Nasal fractures are diagnosed clinically.

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Focus of Initial Treatment

• Hemostasis
• Minimizing swelling
• Treatment of Nasal Fracture
• Ice and Pain control
• Aspirin contraindicated
• Nasal decongestants for up to 3 days
• Nasal fractures are reduced or refered to ENT in
  3 5 days.

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Anterior Epistaxis

• Best controlled by slightly reclining the patient
  and applying direct pressure to the nasal septum
  for 5 to 10 min.
• Apply ice to the back of the neck may help by
  causing reflex vasoconstriction

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Persistent Epistaxis

• Occasionally requires nasal packing with
• Mericel Sponge
• Topical Antibiotic
• Topical Coagulant
• FloSeal
• May use phenylephrine hydrochloride or
  oxymetazoline hydrochloride for vasoconstriction

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Return to Play

• Can be immediate if bleeding is controlled.
• Custom face shields, helmets with face masks, or
  protective devices should be worn for 4 weeks
  after injury.
• Noncontact sports, return to play can be
  immediate if hemostasis controlled.

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Nasal Fracture
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Complications from Nasal Fracture

• Chronic nasal obstruction
• Deviated septum
• Septal hematoma
• Must Rule Out

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Septal Hematoma

• Bulging bluish mass
• Genarally form within hours after injury
• Requires prompt ID, nasal pack and antibiotics
• Must refer to ENT if present

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Nasal Fracture
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Septal Deviation
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Ear Injuries

• Contusions caused by shearing forces applied to
  the external ear are common.
• Most common in wrestling.
• Mechanism of injury is blunt trauma against the
  wrestling mat.
• RESULT AURICULAR HEMATOMA

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The External Ear
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Auricular Hematoma

• Diagnosis established by early
• Ecchymosis
• Erythema and pain
• Palpable collection of fluid
• Swelling of external ear with loss of anatomical
  landmarks

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Auricular Hematoma
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Early Treatment

• Ice apllied eary with continued compression can
  minimize the risk of developing an auricular
  hematoma.
• If hematoma present prompt aspiration required

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Treatment Options

• Aspiration with 18 or 20-gauge needle
• Incision and Drainage using sterile technique
• Compression applied for 7 to 14 days
• Dental roll with through through sutures.
• Antibiotics for 7 10 dayes recommended
• Cephalosporins

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Auricular Hematoma

• I D
• Evacuation of hematoma

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Auricular Hematoma

• Dental Roll Application

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Auricular Hematoma
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Auricular Hematoma
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Return to Play

• Noncontact sports may return to play immediately
• Contact sports require ear protection and
  athletes may return to play 48 hours after dental
  rolls are removed.

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Complications

• Pressure necrosis of the underlying cartilage by
  seperating the perichondrial blood supply from
  the underlying cartilage, results in CAULIFLOWER
  EAR.

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Cauliflower Ear
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Tympanic Membrane Perforation

• Most common Cause pressure caused from OM
• Blunt trauma Barotrauma
• Swimming, diving, highaltitude changes, direct
  contact to the ear

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TM Anatomy
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Normal TM
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TM Perforation
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TM Perforation
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TM Perforation
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TM Perforation Symptoms

• May be Asymptomatic or
• Hearing loss
• Vertigo
• Bloody or serous discharge
• Discomfort worsened by wind or cold

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Diagnosis

• Always consider if mechanism of injury present.
• Otoscopic evaluation

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Treatment

• Keep ear canal dry
• ENT evaluation
• Audiogram
• Otic drops may be required
• Return to play will depend on sport and symptoms

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Facial Fractures

• 75 of facial fractures occur in the
• Mandable
• Zygoma
• Nose
• All Facial Fractures Require Referal

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Diagnosis
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Diagnosis
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Diagnosis
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Diagnosis
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Questions ?