12. Facial injuries

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)



• 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)



• 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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Sep 7, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on 12. Facial injuries

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