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Jeffrey S. Fichera MS PA-C The Ear, Nose, Throat and Plastic Surgery Assoc. Inc.
Facial Injuries in Sports <ul><li>The Athletic Trainer must be prepaired to manage facial injuries, including </li></ul><u...
Facial Injuries in Sports <ul><li>Septal hematomas </li></ul><ul><li>Auricular hematoms </li></ul><ul><li>Ruptured tympani...
Sports Acitivies <ul><li>Account for 3% to 29% of all facial injuries </li></ul><ul><li>Approx. 10% to 42% of all facial f...
Mechanism of Injury <ul><li>Direct Impact – with another players body part (eg, head, fist, elbow) </li></ul><ul><li>Equip...
Return-to-Play <ul><li>Treament requires knowledge of the injury </li></ul><ul><li>Type and serverity of injury </li></ul>...
Initial Exam and Evaluation <ul><li>Pertinent History </li></ul><ul><li>Physicial Exam </li></ul><ul><li>Remember the “ WO...
Soft-Tissue Injuries <ul><li>Contusions </li></ul><ul><li>Abrasions </li></ul><ul><li>Lacerations </li></ul>
Contusions <ul><li>Most commonly encountered facial injury </li></ul><ul><li>Results from blunt trauma to the face </li></...
Abraisions <ul><li>Partial-thickness disruptions of the epidermas </li></ul><ul><li>Commonly results from blunt trauma or ...
Nasal Injuries <ul><li>Epistaxis </li></ul><ul><li>Septal Hematoma </li></ul><ul><li>Fracture </li></ul>
Epistaxis <ul><li>80% of all nose bleeds are from the anterior source ( ie. Kiesselbach’s Plexus ) </li></ul><ul><li>20% a...
Nasal Blood Supply <ul><li>Why the WOW FACTOR? </li></ul><ul><li>External Carotid </li></ul><ul><ul><li>Facial artery ( 2 ...
Nasal Blood Supply <ul><li>Internal Carotid </li></ul><ul><ul><li>Opthalmic artery </li></ul></ul><ul><ul><ul><li>Anterior...
Nasal Blood Supply
EPISTAXIS <ul><li>Cosider nasal fracture as source of epistaxis. </li></ul><ul><li>Athlete may report having heard a “crun...
Focus of Initial Treatment <ul><li>Hemostasis </li></ul><ul><li>Minimizing swelling </li></ul><ul><li>Treatment of Nasal F...
Anterior Epistaxis <ul><li>Best controlled by slightly reclining the patient and applying direct pressure to the nasal sep...
Persistent Epistaxis <ul><li>Occasionally requires nasal packing with: </li></ul><ul><ul><li>Mericel Sponge </li></ul></ul...
Return to Play <ul><li>Can be immediate if bleeding is controlled. </li></ul><ul><li>Custom face shields, helmets with fac...
Nasal Fracture
Complications from Nasal Fracture <ul><li>Chronic nasal obstruction </li></ul><ul><li>Deviated septum </li></ul><ul><li>Se...
Septal Hematoma <ul><li>Bulging bluish mass </li></ul><ul><li>Genarally form within hours after injury </li></ul><ul><li>R...
Nasal Fracture
Septal Deviation
Ear Injuries <ul><li>Contusions caused by shearing forces applied to the external ear are common. </li></ul><ul><li>Most c...
The External Ear
Auricular Hematoma <ul><li>Diagnosis established by early </li></ul><ul><ul><li>Ecchymosis </li></ul></ul><ul><ul><li>Eryt...
Auricular Hematoma
Early Treatment <ul><li>Ice apllied eary with continued compression can minimize the risk of developing an auricular hemat...
Treatment Options <ul><li>Aspiration with 18 or 20-gauge needle </li></ul><ul><li>Incision and Drainage using sterile tech...
Auricular Hematoma <ul><li>I & D </li></ul><ul><li>Evacuation of hematoma </li></ul>
Auricular Hematoma <ul><li>Dental Roll Application </li></ul>
Auricular Hematoma
Auricular Hematoma
Return to Play <ul><li>Noncontact sports may return to play immediately </li></ul><ul><li>Contact sports require ear prote...
Complications <ul><li>Pressure necrosis of the underlying cartilage by seperating the perichondrial blood supply from the ...
Cauliflower Ear
Tympanic Membrane Perforation <ul><li>Most common Cause – pressure caused from OM </li></ul><ul><li>Blunt trauma – Barotra...
TM Anatomy
Normal TM
TM Perforation
TM Perforation
TM Perforation
TM Perforation Symptoms <ul><li>May be Asymptomatic or </li></ul><ul><li>Hearing loss </li></ul><ul><li>Vertigo </li></ul>...
Diagnosis <ul><li>Always consider if mechanism of injury present. </li></ul><ul><li>Otoscopic evaluation </li></ul>
Treatment <ul><li>Keep ear canal dry </li></ul><ul><li>ENT evaluation </li></ul><ul><li>Audiogram </li></ul><ul><li>Otic d...
Facial Fractures <ul><li>75 % of facial fractures occur in the: </li></ul><ul><ul><li>Mandable </li></ul></ul><ul><ul><li>...
Diagnosis Malocclusion, abnormal mandibular movement Trauma to lower face Mandible Signs and Symptoms Mechanism of injury ...
Diagnosis Heard “crack”; ecchymosis; tearing; epistaxis; crepitus Direct or glancing blow Nasal Pain, swelling; ecchymosis...
Diagnosis Elongated, distored face; mobile maxilla; maloccusion High-velosity shearing force to midface Maxilla or LeFort’...
Diagnosis Periorbital edema; ecchymosis; subconjunctival hemorrhage; numbness along infraorbital nerve; diplopia; Decrease...
Questions ?
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Treatment of nasal fracture by Paul of Aegina

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Treatment of nasal fracture by Paul of Aegina

  1. 1. Jeffrey S. Fichera MS PA-C The Ear, Nose, Throat and Plastic Surgery Assoc. Inc.
  2. 2. Facial Injuries in Sports <ul><li>The Athletic Trainer must be prepaired to manage facial injuries, including </li></ul><ul><li>Contusions </li></ul><ul><li>Abrasions </li></ul><ul><li>Laserations </li></ul><ul><li>Nasal fractures </li></ul>
  3. 3. Facial Injuries in Sports <ul><li>Septal hematomas </li></ul><ul><li>Auricular hematoms </li></ul><ul><li>Ruptured tympanic membranes </li></ul><ul><li>Fractures of the facial bones </li></ul>
  4. 4. Sports Acitivies <ul><li>Account for 3% to 29% of all facial injuries </li></ul><ul><li>Approx. 10% to 42% of all facial fractures </li></ul><ul><li>60% to 90% of injures occur in male participants between 10 and 29 years old. </li></ul>
  5. 5. Mechanism of Injury <ul><li>Direct Impact – with another players body part (eg, head, fist, elbow) </li></ul><ul><li>Equipment (eg, ball, puck, goalpost, handlebars ) </li></ul><ul><li>The Ground ( eg, wrestling mat, gym floor) </li></ul><ul><li>Enviroment ( eg, tree, outfield wall ) </li></ul>
  6. 6. Return-to-Play <ul><li>Treament requires knowledge of the injury </li></ul><ul><li>Type and serverity of injury </li></ul><ul><li>Physicial demands of the sport </li></ul>
  7. 7. Initial Exam and Evaluation <ul><li>Pertinent History </li></ul><ul><li>Physicial Exam </li></ul><ul><li>Remember the “ WOW FACTOR ” </li></ul>
  8. 8. Soft-Tissue Injuries <ul><li>Contusions </li></ul><ul><li>Abrasions </li></ul><ul><li>Lacerations </li></ul>
  9. 9. Contusions <ul><li>Most commonly encountered facial injury </li></ul><ul><li>Results from blunt trauma to the face </li></ul><ul><li>Treatment aimed at minimizing inflammatory response ( ice, nonsteroidals) </li></ul>
  10. 10. Abraisions <ul><li>Partial-thickness disruptions of the epidermas </li></ul><ul><li>Commonly results from blunt trauma or sudden forcible friction </li></ul><ul><li>Always consider underlying injury </li></ul><ul><li>40% of all Tetanus (1998-2000) resulted from abrasions and lacerations </li></ul>
  11. 11. Nasal Injuries <ul><li>Epistaxis </li></ul><ul><li>Septal Hematoma </li></ul><ul><li>Fracture </li></ul>
  12. 12. Epistaxis <ul><li>80% of all nose bleeds are from the anterior source ( ie. Kiesselbach’s Plexus ) </li></ul><ul><li>20% are posterior and usually a disease of the middle aged and elderly </li></ul>
  13. 13. Nasal Blood Supply <ul><li>Why the WOW FACTOR? </li></ul><ul><li>External Carotid </li></ul><ul><ul><li>Facial artery ( 2 branchs ant. Septum, ala ) </li></ul></ul><ul><ul><li>Internal maxillary ( most important ) </li></ul></ul><ul><ul><ul><li>Terminal branch of EC gives rise to </li></ul></ul></ul><ul><ul><ul><ul><li>Sphenopalatine </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nasopaltine </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Greater palatine </li></ul></ul></ul></ul>
  14. 14. Nasal Blood Supply <ul><li>Internal Carotid </li></ul><ul><ul><li>Opthalmic artery </li></ul></ul><ul><ul><ul><li>Anterior and Posterior ethmoid artery </li></ul></ul></ul>
  15. 15. Nasal Blood Supply
  16. 16. EPISTAXIS <ul><li>Cosider nasal fracture as source of epistaxis. </li></ul><ul><li>Athlete may report having heard a “crunch” or “crack”. </li></ul><ul><li>Nasal fractures are diagnosed clinically. </li></ul>
  17. 17. Focus of Initial Treatment <ul><li>Hemostasis </li></ul><ul><li>Minimizing swelling </li></ul><ul><li>Treatment of Nasal Fracture </li></ul><ul><ul><li>Ice and Pain control </li></ul></ul><ul><ul><li>Aspirin contraindicated </li></ul></ul><ul><ul><li>Nasal decongestants for up to 3 days </li></ul></ul><ul><ul><li>Nasal fractures are reduced or refered to ENT in 3 – 5 days. </li></ul></ul>
  18. 18. Anterior Epistaxis <ul><li>Best controlled by slightly reclining the patient and applying direct pressure to the nasal septum for 5 to 10 min. </li></ul><ul><li>Apply ice to the back of the neck may help by causing reflex vasoconstriction </li></ul>
  19. 19. Persistent Epistaxis <ul><li>Occasionally requires nasal packing with: </li></ul><ul><ul><li>Mericel Sponge </li></ul></ul><ul><ul><ul><li>Topical Antibiotic </li></ul></ul></ul><ul><ul><ul><li>Topical Coagulant </li></ul></ul></ul><ul><ul><ul><ul><li>FloSeal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>May use phenylephrine hydrochloride or oxymetazoline hydrochloride for vasoconstriction </li></ul></ul></ul></ul>
  20. 20. Return to Play <ul><li>Can be immediate if bleeding is controlled. </li></ul><ul><li>Custom face shields, helmets with face masks, or protective devices should be worn for 4 weeks after injury. </li></ul><ul><li>Noncontact sports, return to play can be immediate if hemostasis controlled. </li></ul>
  21. 21. Nasal Fracture
  22. 22. Complications from Nasal Fracture <ul><li>Chronic nasal obstruction </li></ul><ul><li>Deviated septum </li></ul><ul><li>Septal hematoma </li></ul><ul><ul><li>Must Rule Out </li></ul></ul>
  23. 23. Septal Hematoma <ul><li>Bulging bluish mass </li></ul><ul><li>Genarally form within hours after injury </li></ul><ul><li>Requires prompt I&D, nasal pack and antibiotics </li></ul><ul><li>Must refer to ENT if present </li></ul>
  24. 24. Nasal Fracture
  25. 25. Septal Deviation
  26. 26. Ear Injuries <ul><li>Contusions caused by shearing forces applied to the external ear are common. </li></ul><ul><li>Most common in wrestling. </li></ul><ul><li>Mechanism of injury is blunt trauma against the wrestling mat. </li></ul><ul><li>RESULT = AURICULAR HEMATOMA </li></ul>
  27. 27. The External Ear
  28. 28. Auricular Hematoma <ul><li>Diagnosis established by early </li></ul><ul><ul><li>Ecchymosis </li></ul></ul><ul><ul><li>Erythema and pain </li></ul></ul><ul><ul><li>Palpable collection of fluid </li></ul></ul><ul><ul><li>Swelling of external ear with loss of anatomical landmarks </li></ul></ul>
  29. 29. Auricular Hematoma
  30. 30. Early Treatment <ul><li>Ice apllied eary with continued compression can minimize the risk of developing an auricular hematoma. </li></ul><ul><li>If hematoma present – prompt aspiration required </li></ul>
  31. 31. Treatment Options <ul><li>Aspiration with 18 or 20-gauge needle </li></ul><ul><li>Incision and Drainage using sterile technique </li></ul><ul><li>Compression applied for 7 to 14 days </li></ul><ul><ul><li>Dental roll with through & through sutures. </li></ul></ul><ul><ul><li>Antibiotics for 7 – 10 dayes recommended </li></ul></ul><ul><ul><li>Cephalosporins </li></ul></ul>
  32. 32. Auricular Hematoma <ul><li>I & D </li></ul><ul><li>Evacuation of hematoma </li></ul>
  33. 33. Auricular Hematoma <ul><li>Dental Roll Application </li></ul>
  34. 34. Auricular Hematoma
  35. 35. Auricular Hematoma
  36. 36. Return to Play <ul><li>Noncontact sports may return to play immediately </li></ul><ul><li>Contact sports require ear protection and athletes may return to play 48 hours after dental rolls are removed. </li></ul>
  37. 37. Complications <ul><li>Pressure necrosis of the underlying cartilage by seperating the perichondrial blood supply from the underlying cartilage, results in CAULIFLOWER EAR. </li></ul>
  38. 38. Cauliflower Ear
  39. 39. Tympanic Membrane Perforation <ul><li>Most common Cause – pressure caused from OM </li></ul><ul><li>Blunt trauma – Barotrauma </li></ul><ul><li>Swimming, diving, highaltitude changes, direct contact to the ear </li></ul>
  40. 40. TM Anatomy
  41. 41. Normal TM
  42. 42. TM Perforation
  43. 43. TM Perforation
  44. 44. TM Perforation
  45. 45. TM Perforation Symptoms <ul><li>May be Asymptomatic or </li></ul><ul><li>Hearing loss </li></ul><ul><li>Vertigo </li></ul><ul><li>Bloody or serous discharge </li></ul><ul><li>Discomfort worsened by wind or cold </li></ul>
  46. 46. Diagnosis <ul><li>Always consider if mechanism of injury present. </li></ul><ul><li>Otoscopic evaluation </li></ul>
  47. 47. Treatment <ul><li>Keep ear canal dry </li></ul><ul><li>ENT evaluation </li></ul><ul><li>Audiogram </li></ul><ul><li>Otic drops may be required </li></ul><ul><li>Return to play will depend on sport and symptoms </li></ul>
  48. 48. Facial Fractures <ul><li>75 % of facial fractures occur in the: </li></ul><ul><ul><li>Mandable </li></ul></ul><ul><ul><li>Zygoma </li></ul></ul><ul><ul><li>Nose </li></ul></ul><ul><ul><li>All Facial Fractures Require Referal </li></ul></ul>
  49. 49. Diagnosis Malocclusion, abnormal mandibular movement Trauma to lower face Mandible Signs and Symptoms Mechanism of injury Type
  50. 50. Diagnosis Heard “crack”; ecchymosis; tearing; epistaxis; crepitus Direct or glancing blow Nasal Pain, swelling; ecchymosis over fracture site; numbness along infraorbital nerve Blunt trauma to the cheek Zygoma
  51. 51. Diagnosis Elongated, distored face; mobile maxilla; maloccusion High-velosity shearing force to midface Maxilla or LeFort’s Central depression or asymmetry of cheek bone; trismus Blunt trauma to cheek Zygomatic Arch
  52. 52. Diagnosis Periorbital edema; ecchymosis; subconjunctival hemorrhage; numbness along infraorbital nerve; diplopia; Decreased upward gaze; sunken globe Direct trauma to globe (eg, from ball, elbow) Orbital Blowout
  53. 53. Questions ?

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