Facial Injuries

Anatomy of the Face

The main bones of the face consist of the skullcap (calvaria), the nasal and cheek (zygoma) bones and the upper (maxilla) and lower (mandible) jaw bones. In sport, injuries to this region are usually associated with a direct forceful impact to the face and/or head.

Soft Tissue Injuries to the face

Soft tissue injuries to the face are common in racket sports and martial arts but may occur in any sport. They often result in the facial or scalp area becoming either cut (lacerated) and/or bruised (contused) as a result of direct trauma. Immediate treatment should aim to stop the bleeding or swelling in the area as quickly as possible.

Treatment of soft tissue face injuries

• To reduce swelling, ice in addition to pressure can be applied to the area.
• In order to control bleeding, direct pressure over the wound can be applied with a sterile gauze. If an athlete is bleeding then they must be removed from the field of play in order to minimise the risk of infection.
• Once off the field all foreign material such as mud or grass will be removed from the wound and the area should be cleaned with an antiseptic wipe.
• As a rule of thumb lacerations greater than .5 cm should be closed once cleaned. This can be achieved by using adhesive strips (steristrips), however if the player intends to return to the playing field then the affected area must be dressed appropriately to prevent further damage.
• If the wound is deeper and the bleeding cannot be stopped then seek medical advice.
• This may be common in the lip and eye brow areas and medical stitching (suturing) may be required. For deeper wounds a tetanus shot should be administered. Also, in the event that the injury may be contaminated by another player saliva, as in bite wounds, anti-biotics should be given.

Nosebleed

• Nose bleeds happen as a result of injury to the division between the two nasal passages (nasal septum) which contains a high proportion of blood vessels.

  Treatment of nosebleeds

  • Compression should be applied as quickly as possible to the soft area just below the bridge of the nose, preferably with ice to stop bleeding.
  • It is important to lean forward as this facilitates the blood to run out of the nose. Leaning back may cause swallowing of the blood which can lead to nausea and vomiting.

Complications arising from nosebleeds: Septal Hemotoma

This is caused by bleeding within the tissue of the nasal septa. This forms a clot that can block the nasal passage and may cause difficulty in breathing. In this condition medical intervention must be sought to remove the clot.

Facial Fractures:

Symptoms of a facial fracture

• Pain, swelling and bruising are the most obvious symptoms.
• Deformity may also be present. This may result in some asymmetry in one side of the face to the other.

Signs and Symptoms of a Fractured Cheekbone

• Swelling, bruising, numbness cheek flattening or any jaw dysfunction.
• Note that this fracture may also be associated with a fractured eye socket which may lead to visual disturbance such as double vision, or limited eye movement.

Treatment of fractured cheekbones

• Medical treatment must be sought immediately. Surgery may be necessary to stabilise the fracture.

Fractured Jaw-bone

Two different areas of the jaw may be fractured namely the upper and lower jaw bones.

Lower Jaw-bone (Mandibular) Fractures

• This is a very common injury associated with all sports and usually is a result of a direct trauma to jaw. The mandible commonly fractures in more than one place.

Signs and Symptoms

• There may misalignment of one or more teeth.
• Alternatively a whole segment of teeth may be seen to move independently.
• Bruising may be present on the floor of the mouth.

Treatment

• This is a very serious injury and requires urgent medical attention.
• The patient is usually best placed in sitting forward position ensuring that he/she can breathe correctly.
• Any displaced teeth or tooth debris must be removed from the person's mouth.
• If the patient is concussed then they may be placed on their side, again clearing their mouth of any debris.
• As a safety precaution the tongue may need to be stabilised and held in place to avoid swallowing and so obstructing the air way.

Upper Jaw-bone (maxillary) fractures

Signs and Symptoms

• A 'lengthening' of the face
• Bruising
• Problems associated with biting .i.e. jaw alignment.

Treatment of upper jaw fractures

• Make sure the air-way is clear so the affected person can breathe.
• If the person is conscious then he/she should be made to sit in a forward position.
• Seek medical advice immediately