chapter 12. Facial injuries
JS Butler, F Coffey and F Kearns
INTRODUCTION
Facial injuries are common in sport, particularly in contact sports. Typical injuries range from simple cuts and mild abrasions to a facial bone injury or broken jaw, with possible life-threatening airway problems. It is important to remember that there can be an associated head and neck injury.
This chapter is divided into four parts:
• Facial bones: nose and cheek bones
• Eyes and ears
• Jaw and mouth
• Cuts to the face
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FACIAL BONES: NOSE AND CHEEK BONES
What should I check for?
Speak to the player
• ‘Are you OK?’ ‘Where were you hit?’
• ‘Where is the pain?’ ‘Did you hear a crack?’
• ‘Do you feel any numbness on your face’
• ‘Do you have difficulty breathing?’
• ‘Can you see me OK?’ (blurring/double vision)
Problem identification
• A ‘crack’ usually indicates a broken bone
• Numbness usually indicates a compressed nerve
• Visual disturbance may indicate an eye socket fracture or an injury to the eye itself
• Facial fractures may cause airway compromise and affect breathing
• Is there swelling/redness/deformity/bloodshot eye/abrasion/laceration?
• Compare the injured area with the uninjured side:
• Is there asymmetry of the face? Asymmetry normally indicates swelling or a fracture
• Is the nose displaced or the cheekbone depressed?
Rule out serious injury
• Is there a head injury?
• Injury of the spine?
• If worried about either of these, go to the relevant chapter
Touch (use gloves)
• Feel gently around facial bones for tenderness or a step (possible bone injury or break)
• Feel gently around the rim of the eye socket for tenderness or a step (possible broken bone) (Fig. 12.1A)
• Get the player to clench their teeth, assessing for malalignment (this might include a palate fracture)
• Place your finger and thumb in the player’s mouth, holding on to the upper jaw. Assess whether the jaw is stable on gentle movement
Skills assessment
• Ask the player to blow out their cheeks, smile, whistle and wrinkle their forehead (Fig. 12.1B). If not normal, the player needs specialist review
What should I do?
Talk to the player
• Reassure and explain what you are doing and why
Remove from the pitch
• Do not remove a player from the pitch unless it is safe to do so
• Minor injuries (Green zone) may be dealt with on the pitch
• Removing the player allows you to reassess the situation and make a less pressured and more informed decision on the sideline
• When an injury is identified, assess whether it is safe to remove the player from the pitch without additional splinting or assistance
Emergency management
• ABC emergency management
• Emergency transfer to hospital if serious injury is suspected
• Occasionally a player with broken facial bones will insist on sitting up and leaning forward to get their breath
Avoid further injury
• Get the player off the field of play for further assessment/management
• A player must not play on with a broken nose or cheekbone
Treat the problem
Nosebleed
Do not let the head tilt back.
• Ask the player to sit down. Tilt the head forwards to allow the blood to drain from the nostrils
• Put on gloves. Apply pressure to the fleshy part of the nose (not the bridge of the nose) using a clean gauze or tissue (Fig. 12.2)
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| Fig. 12.2 |
• Most bleeding should stop within 10-15 minutes
• If bleeding stops and restarts, tell the player to reapply pressure
• If the bleeding lasts more than 30 minutes, send the player to hospital
• A doctor or other trained person may insert a nasal tampon dipped in adrenaline (epinephrine)
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Broken nose
• Ask the player if they have broken their nose before. The crooked position may be normal
• Place a cold compress on the nose
• A doctor or trained person may try to correct the deformity. Explain to the player that this may be painful
• Place your thumb and index finger of your left hand on the bridge of the nose
• The player will often describe a ‘click’ or ‘clunk’
• Observe the nose to assess straightness. If straight, apply tape to hold the nose in place
• If it is very difficult to correct, the player may need an anaesthetic. Send to hospital
• The player should be assessed by a doctor to make sure that the septum in between the nostrils is not deviated. If it is still deviated following correction, the player should go to hospital
Broken cheekbones
• If there are any fractures of the cheekbones or face, place a cold compress over the area
• Apply pressure to any cuts or lacerations with a sterile gauze
• Send the player to hospital immediately
EYES AND EARS
Eyes
Red Zone
• Broken eye socket
• Eyelid laceration
• Damaged eyeball
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