FACIAL LACERATIONS AT RINGSIDE · 2018. 4. 1. · Motor Branches of the Facial Nerve – CN VII Car...
Transcript of FACIAL LACERATIONS AT RINGSIDE · 2018. 4. 1. · Motor Branches of the Facial Nerve – CN VII Car...
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FACIALLACERATIONSATRINGSIDE
USABOXING-MEDICALHANDBOOKandMEDICALRULESofAIBAOPENBOXING-AsadaptedforuseintheUnitedStatesfromthe2013AIBAEdiLon
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MEDSCHOOLANATOMY
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SurfaceAnatomyoftheFace
Nasolabial Fold
Submandibular Gland
Mandible
Mental Protuberance
Philtrum of Superior Lip (Labia)
Buccal region Vermilion Border
Nares
Labial Commisure
Parotid
Infraorbital Margin
Zygoma
Orbit
Pinna
Supraorbital Ridge
Submental Region
MajorStructuresoftheSuperficialFace• Eye,noseandpieholes• MusclesofFacial
Expression
• ParoLdglandandduct• Branchesofthefacial
nerve
• Branchesofthetrigeminalnerve
• Facialarteryandthesuperficialtemporalartery
• Veinsdrainingtotheinternalandexternaljugularveins
DissecLonoftheSuperficialFaceSuperficial Temporal A&V
Greater Auricular N
External Jugular V
Sterno
masto
id M
Mentalis M. Facial A&V Platysma M.
Parotid Gland
Parotid Duct
Transverse Facial A
Buccinator
Zygomaticus Major
Orbicularis Oculi
Branches of the facial N
Auriculotemporal N
ArteriestotheFace
Facial Artery is anterior to the Facial
V, in front of Masseter M.
Superficial Temporal A
Anterior Branch
Posterior Branch
Transverse Facial A.
Facial Artery
Angular ArterySuperior Labial
Artery
Inferior Labial Artery
There would also be a supra- and infra-
orbital arteries, lacrimal artery and a few other small ones.
Lingual Artery
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Cranial Cavity Orbit
Pterygoid Plexus
Cavernous Sinus
CranialNervesAssociatedWiththeFace• TrigeminalNerve
– Sensorytotheskin– Threedivisions
• FacialNerve– MotortoMusclesofFacialExpression
– LacrimalandallSalivarySecreLons(Except1)
• GlossopharyngealNerve– ParoLdSecreLons
MotorBranchesoftheFacialNerve–CNVII
Car - Cervical
To – Temporal (Frontal)
(Top of Orbic Oculi)
Zanzibar – Zygomatic (Bottom of Orbic Oculi)
By – Buccal (Top of Orbic Oris)
Motor – Mandibular (Bottom of Orbic Oris) Exits Stylomastoid Foramen
Posterior Auricular
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USABOXINGMANUAL
RINGSIDEPRACTICE
THISWASTHESTANDARD
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UpdatedImage
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ADEEPCUTNEARTHESE6HOLESISDANGEROUS
TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace THEYALLLINEUP
WTHEPUPIL
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DANGEROUSIFDEEP!
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DANGEROUSIFDEEP!
90%OFALLLACS
ABSOLUTEInjuriesAroundtheEyes:
TarsalPlatesandNasolacrimalDuct
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Injuriesthatincludetheeye/obscurevision
EyebyEscher,1946
! Thebasicprincipleofhandlingcutsaroundtheeyeisthat,ifacutcausesenoughbleedingtoimpairvision,theboutshouldbestopped.
! MostcutswillNOTrequirethattheboutbestopped.
SHOWSTOPPER?
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DANGEROUSIFDEEP!
UpdatedImage
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SummeryofFacialLaceraLons SummaryofZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
SummaryofZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
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PressurePointstoStopBleeding
SuperficialTemporalArtery
TransverseFacialArtery
AngularArtery
FacialArtery
SuperiorLabialArtery
InferiorLabialArtery
LaceraLonZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
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LaceraLonZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
LARRYLOVELACE,DO,FACEP,DABEM,DABFM,DABFE,ACSM/ARP
RINGSIDEARP.ORG
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DANGEROUSIFDEEP!
DANGEROUSIFDEEP!
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TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace
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TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace
TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace PressurePointstoStopBleeding
SuperficialTemporalArtery
TransverseFacialArtery
AngularArtery
FacialArtery
SuperiorLabialArtery
InferiorLabialArtery
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Superficial Temporal A
Transverse Facial A.
InjuriesoftheFace
5.3.1.Occasionallyacutwillbeinanareawheredeepstructuresmaybeinjured.Inboxing,asthesearebluntinjuriesandnotsharpinjuries,itissLllunusualtohavetostopaboutunlesstheselaceraLonsarequitedeepandsevere.However,thefollowinglaceraLonsshouldbeevaluatedwiththisinmind.
BlowoutofOrbitHitintheeye(blackorswolleneye)Andeitherorbothofthe
nexttwo– Numbnesstowardupperteeth– Doublevisiononupwardgaze
Answer!Theflooroftheorbitisblown!
– Infraorbitalnerveisinterrupted– InferiorRectusmaybeentrapped
AnteriorCranialFossa
Orbit
MaxillarySinus
MRIofFace
InjuriesaroundtheEyeSupraorbital/Supratrochlear
This muscle is superficial to the nerve and artery so that a cut in this region would have to be very deep to injure the nerve
and artery
InjuriesaroundtheEye–InfraorbitalNerveandArtery
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FacialNerve Video
LaceraLonsovermedialeye5.3.1.1.2.Cutsmediallyoverthelarcrimalductareamayextendintothenasolachrymalduct.
LaceraLonstotheeyelid
5.3.1.1.4.Cutsontheeyeliditselfcoulddamagethetarsalplateortheglobeitselfmayhavebeeninjured.
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LaceraLonsofthelip5.3.1.1.5.VerLcalcutsthroughthevermillionborderofthelipshouldstoptheboutbecauseofthepotenLalforfurthertearingofthelipfromsubsequenttrauma.
CutsovertheEye5.3.1.1.1.Cutsoverthesupraorbitalnerveorthesupratrochlearnerve,iftheyaredeepenough,maydamagethenerve.
LaceraLoninferiortotheeye
5.3.1.1.3.Cutsovertheinfraorbitalnerve,ifdeepenough,coulddamagethenerve.
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ResponsibiliLesforLaceraLonsThephysicianmustbepreparedtoevaluatecutsatringside.Thebasicprincipleofhandlingcutsaroundtheeyeisthat,ifacutcausesenoughbleedingtoimpairvision,theboutshouldbestopped.MostcutswillNOTrequirethattheboutbestopped.
Cutsaroundoronthebridgeofthenose AnteriorNoseBleed• Mostnosebleedwillbeanteriorandintheabsenceoffractureself-limiLng
• Inanynosebleeditisimportanttolookdownthethroat
• IfthereisonlyalinlebloodinthepharynxitisprobablyananteriorBleed
• Mostnosebleedswillstopontheirownorwithexternalpressure.
• Amessynosebleedisnotnecessarilyaseriousnosebleed
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PosteriorNoseBleeds• DeterminaLonofposteriorbleedingshouldalsobedonebytonguedepressionandpenlightobservaLon.
• Brightbloodintheoralpharynx–behindtheposteriorpillarisaclearsignofaposteriorbleed
• Ifthereareclotsinthepharynxortheboxerisspiongclots,theboutshouldbestopped
• Mostnosebleedswillstopontheirownorwithexternalpressure.
• Amessynosebleedisnotnecessarilyaseriousnosebleed
WhatcanbedoneabouttheLaceraLon
5.3.3.Nodressingofcutsisallowedexceptforcollodionorsteristrips.SubcuLcularclosureofcertaincutswithacoveringofcollodionorsteristripsmayallowwinningboxerstoconLnueinatournament.Iftheychoosethisapproach,theyshouldbemadeawarethatthereisariskthatthewoundmayreopenduringtheboutandrequirefurtherrepairaperthebout.Itcouldbebadenoughifitreopenstoterminatethebout.Itcouldcausefurtherdamage.
Howtohandlenosebleeds5.4.1.TheiniLalevaluaLonshoulddeterminethepresenceofafracture.Gentlehandlingofanosebleedisnecessarysoasnottofurtheraggravateorcompoundafracture.5.4.2.Ifnofractureisfelt,thephysicianmustthenevaluatethecharacterofthebleeding(i.e.venousvs.briskarterialgushing).Boutsarestoppedforarterialbleeding(rareinthissituaLon).5.4.3.DeterminaLonofposteriorbleedingshouldalsobedonebytonguedepressionandpenlightobservaLon.Ifthereareclotsintheposteriorpharynxortheboxerisspiongclots,theboutshouldbestopped.5.4.4.Massivevenousbleedingmaybecausetostopabout.5.4.5.Nosebleedsshouldstopboutsformedicalreasons.Mostnosebleedswillstopontheirownorwithexternalpressure.Amessynosebleedisnotnecessarilyaseriousnosebleed.5.4.6.ThedoctormayalsostoptheboutiftheboxerdoesnotwanttoconLnueorinyoungboxerswheretheexperiencecanbefrightening.
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SummaryofZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
SummaryofZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
SummaryofZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
LaceraLonZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
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LaceraLonZones
LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD
PressurePointstoStopBleeding
SuperficialTemporalArtery
TransverseFacialArtery
AngularArtery
FacialArtery
SuperiorLabialArtery
InferiorLabialArtery
PressurePointstoStopBleeding
SuperficialTemporalArtery
TransverseFacialArtery
AngularArtery
FacialArtery
SuperiorLabialArtery
InferiorLabialArtery
PressurePointstoStopBleeding
SuperficialTemporalArtery
TransverseFacialArtery
AngularArtery
FacialArtery
SuperiorLabialArtery
InferiorLabialArtery