Head and Facial Conditions. Anatomy of Head and Face Bones of skull Bones of skull Cranium Cranium...

Head and Facial Head and Facial ConditionsConditions

Anatomy of Head and FaceAnatomy of Head and Face

Bones of skullBones of skull CraniumCranium

Protects the brainProtects the brain FacialFacial

Provide the structure of the faceProvide the structure of the face Form the sinuses, orbits of the eyes, nasal cavity, and Form the sinuses, orbits of the eyes, nasal cavity, and

the mouththe mouth ScalpScalp

Protective function Protective function Extensive blood supplyExtensive blood supply

Anatomy of Head and Face Anatomy of Head and Face (cont.)(cont.)


BrainBrain Major regions Major regions

Cerebral hemispheresCerebral hemispheres DiencephalonDiencephalon BrainstemBrainstem Cerebellum Cerebellum


Meninges Meninges Protective tissue that encloses brain Protective tissue that encloses brain

and spinal cordand spinal cord Dura mater; arachnoid mater; pia Dura mater; arachnoid mater; pia

mater mater


EyesEyes ConjunctivaConjunctiva Lacrimal glandsLacrimal glands Tunics: sclera; choroid; retinaTunics: sclera; choroid; retina CorneaCornea


NoseNose Composed of bone and hyaline Composed of bone and hyaline

cartilagecartilage Nasal septumNasal septum


EarEar Major areasMajor areas

Outer ear (auricle and external Outer ear (auricle and external auditory canal)auditory canal)

Middle ear (tympanic membrane)Middle ear (tympanic membrane) Inner ear (labyrinth) Inner ear (labyrinth)


NervesNerves Cranial nerves Cranial nerves

Motor functions, Motor functions, sensory functions, or sensory functions, or bothboth

Numbered and Numbered and named in named in accordance with accordance with their functions their functions

Blood vesselsBlood vessels Common carotidCommon carotid VertebralVertebral

Prevention of Head and Facial Prevention of Head and Facial InjuriesInjuries

Protective equipmentProtective equipment HelmetsHelmets Face guardsFace guards Mouth guardsMouth guards Eye wearEye wear Ear wearEar wear Throat protectorsThroat protectors

Scalp InjuriesScalp Injuries

Highly vascularized; bleeds freelyHighly vascularized; bleeds freely LacerationLaceration

Control bleedingControl bleeding Prevent contaminationPrevent contamination Assess for skull fracture (fx)Assess for skull fracture (fx) Management: Management:

If no fx, cleanse, cover, and referIf no fx, cleanse, cover, and refer Abrasions and contusionsAbrasions and contusions

Cleanse; ice and pressureCleanse; ice and pressure 24 hours: no improvement – refer24 hours: no improvement – refer

Cranial Injury MechanismsCranial Injury Mechanisms

Injury dependent on:Injury dependent on: Material properties of skullMaterial properties of skull Thickness of skullThickness of skull Magnitude and direction Magnitude and direction

of forceof force Size of impact areaSize of impact area

Bone deforms and Bone deforms and bends inwardbends inward Inner border – tensile Inner border – tensile

strainstrain Outer border – Outer border –

compressedcompressed

Cranial Injury Mechanisms Cranial Injury Mechanisms (cont.)(cont.)

Brain Brain accelerationacceleration Shear, tensile, Shear, tensile,

and compression and compression strains within strains within brain brain

Contrecoup Contrecoup injuryinjury

Cranial Injury Mechanisms Cranial Injury Mechanisms (cont.)(cont.)

Focal injuryFocal injury Localized damageLocalized damage Epidural, subdural, or intracerebral hematomas Epidural, subdural, or intracerebral hematomas

Diffuse injuryDiffuse injury Widespread disruption Widespread disruption ConcussionConcussion

Accurate assessment of head injury is Accurate assessment of head injury is essential essential

Conscious, ambulatory individual should not Conscious, ambulatory individual should not be considered to have only a minor injurybe considered to have only a minor injury

Skull FractureSkull Fracture

TypesTypes Linear Linear Comminuted Comminuted Depressed Depressed BasilarBasilar

Skull Fracture (cont.)Skull Fracture (cont.)

Potential for varying signs and Potential for varying signs and symptoms (S&S)symptoms (S&S) Visible deformity–do not be misled by a Visible deformity–do not be misled by a ““goose egggoose egg””; a fracture may be under the ; a fracture may be under the sitesite

Deep laceration or severe bruise to scalpDeep laceration or severe bruise to scalp Palpable depression or crepitusPalpable depression or crepitus Unequal pupilsUnequal pupils Raccoon eyes or BattleRaccoon eyes or Battle’’s signs sign

Skull Fracture (cont.)Skull Fracture (cont.)

Bleeding or CSF from nose and/or earBleeding or CSF from nose and/or ear Loss of smellLoss of smell Loss of sight or major vision Loss of sight or major vision

disturbancesdisturbances Unconsciousness Unconsciousness 2 minutes after direct 2 minutes after direct

trauma to the headtrauma to the head Management: activation of EMSManagement: activation of EMS

Facial ConditionsFacial Conditions

Facial soft tissue conditionsFacial soft tissue conditions Contusions, abrasions, and lacerations Contusions, abrasions, and lacerations

are managed the same as elsewhere are managed the same as elsewhere on the body on the body

Complicated injuries—immediate Complicated injuries—immediate physician referralphysician referral

Facial Conditions (cont.)Facial Conditions (cont.)

Temporomandibular joint conditionsTemporomandibular joint conditions S&SS&S

Inability to open and/or close mouth (dislocation Inability to open and/or close mouth (dislocation and meniscus displacement) and meniscus displacement)

MalocclusionMalocclusion Joint crepitus with opening and closing Joint crepitus with opening and closing Pain with opening and biting Pain with opening and biting Deviation of the mandible on opening (toward Deviation of the mandible on opening (toward

side of injury)side of injury)


FracturesFractures Zygomatic Zygomatic

S&S: cheek appears flat or depressed, double vision, S&S: cheek appears flat or depressed, double vision, numbness in affected cheeknumbness in affected cheek

Management: ice, immediate referralManagement: ice, immediate referral MandibularMandibular

Common: mandibular angle and condylesCommon: mandibular angle and condyles S&S: malocclusion, changes in speech, oral bleeding, S&S: malocclusion, changes in speech, oral bleeding,

+ tongue blade+ tongue blade Management: ice, immediate referralManagement: ice, immediate referral


FracturesFractures Maxillary Maxillary

LeFort fx (upper jaw)LeFort fx (upper jaw) S&S: appearance of longer face, nasal bleeding, S&S: appearance of longer face, nasal bleeding,

malocclusion, nasal deformity, ecchymosismalocclusion, nasal deformity, ecchymosis Management: ice, immediate referralManagement: ice, immediate referral

Facial Facial ““red flagsred flags””

Nasal ConditionsNasal Conditions

EpistaxisEpistaxis Anterior – bleeding from anterior septumAnterior – bleeding from anterior septum

Posterior – bleeding from lateral wallPosterior – bleeding from lateral wall Management: ice, mild pressure, slight forward Management: ice, mild pressure, slight forward

head tilt; nasal plug; head tilt; nasal plug; 5 minutes – physician referral5 minutes – physician referral Deviated septumDeviated septum

S&SS&S Consistent difference in airflow between the 2 sides of the Consistent difference in airflow between the 2 sides of the

nose when one nostril is blockednose when one nostril is blocked Confirm using otoscope Confirm using otoscope

Management: physician referralManagement: physician referral

Nasal Conditions (cont.)Nasal Conditions (cont.)

FracturesFractures Most common: lateral displacementMost common: lateral displacement Range of severity variesRange of severity varies S&SS&S

Asymmetry – especially with lateral forceAsymmetry – especially with lateral force EpistaxisEpistaxis CrepitusCrepitus

Management: control bleeding; referManagement: control bleeding; refer Nasal Nasal ““red flagsred flags””

Oral and Dental ConditionsOral and Dental Conditions

Periodontal diseasePeriodontal disease S&S of gingivitis S&S of gingivitis

Tender, swollen, or bleeding gumsTender, swollen, or bleeding gums Change in the gums' color from pink to Change in the gums' color from pink to

dusky reddusky red Plaque and bacteria that cover the teeth Plaque and bacteria that cover the teeth

not readily visiblenot readily visible

Oral and Dental Conditions Oral and Dental Conditions (cont.)(cont.)

S&S of periodontitis S&S of periodontitis Swollen or recessed gumsSwollen or recessed gums Unpleasant taste in the mouthUnpleasant taste in the mouth Bad breathBad breath Tooth painTooth pain Drainage or pus around one or more teeth Drainage or pus around one or more teeth

Management: referral to dentistManagement: referral to dentist


Dental caries (tooth decay)Dental caries (tooth decay) Primarily caused by plaque...dissolves the tooth Primarily caused by plaque...dissolves the tooth

enamel…allows bacteria to infect the center of the enamel…allows bacteria to infect the center of the tooth tooth

S&SS&S Pain during chewing Pain during chewing Sensitivity to hot/cold foods and beveragesSensitivity to hot/cold foods and beverages If tooth abscess is present:If tooth abscess is present:

Throbbing painThrobbing pain Sharp or shooting painSharp or shooting pain

Management: refer to dentistManagement: refer to dentist


Mouth lacerationsMouth lacerations Minor lacerations are the same as in other lacerations Minor lacerations are the same as in other lacerations Lip and tongue lacerations: require special suturingLip and tongue lacerations: require special suturing

Loose teethLoose teeth Displaced outward or lateral: attempt to place back in Displaced outward or lateral: attempt to place back in

normal positionnormal position Intruded: immediate referral to dentistIntruded: immediate referral to dentist


Fractured toothFractured tooth Enamel: no symptomsEnamel: no symptoms Dentin: pain and increased sensitivity to Dentin: pain and increased sensitivity to

heat and coldheat and cold Pulp or root: severe pain and sensitivityPulp or root: severe pain and sensitivity Management: refer to dentistManagement: refer to dentist


Dislocated toothDislocated tooth Time is of the essence; referTime is of the essence; refer Hold tooth by crownHold tooth by crown Do not rub the tooth or remove any Do not rub the tooth or remove any

dirt; milk or salinedirt; milk or saline Oral and dental Oral and dental ““red flagsred flags””

Ear ConditionsEar Conditions

Cauliflower ear (auricular hematoma)Cauliflower ear (auricular hematoma) Repeated trauma pulls cartilage away from Repeated trauma pulls cartilage away from

perichondrium – hematoma formsperichondrium – hematoma forms Untreated – forms a fibrosisUntreated – forms a fibrosis Management: ice; possible aspiration by Management: ice; possible aspiration by

physicianphysician Key is prevention!Key is prevention!

Impacted cerumen (wax)Impacted cerumen (wax) Possible hearing loss or muffled hearing Possible hearing loss or muffled hearing Management: irrigate canal with warm water Management: irrigate canal with warm water

Ear Conditions (cont.)Ear Conditions (cont.)

Otitis externa (swimmerOtitis externa (swimmer’’s ear)s ear) Bacterial infection to lining of external auditory canalBacterial infection to lining of external auditory canal S&S: pain, itchingS&S: pain, itching Management: ear drops, custom ear plugsManagement: ear drops, custom ear plugs

Otitis mediaOtitis media Middle ear infection due to bacteria or virusMiddle ear infection due to bacteria or virus S&S: earache, hearing difficulty, possible serous S&S: earache, hearing difficulty, possible serous

otitisotitis Management: physician referralManagement: physician referral


Tympanic membrane ruptureTympanic membrane rupture Caused by:Caused by:

Infection Infection Direct trauma Direct trauma Changes in pressure Changes in pressure Loud, sudden noises Loud, sudden noises Foreign objects in the earForeign objects in the ear


S&SS&S Very painfulVery painful TinnitusTinnitus Pus-filled or bloody drainage from the earPus-filled or bloody drainage from the ear Sudden decrease in ear pain followed by Sudden decrease in ear pain followed by

drainagedrainage Hearing loss Hearing loss

Management: physician referralManagement: physician referral Ear Ear ““red flagsred flags””

Eye ConditionsEye Conditions

Preorbital ecchymosis (black eye)Preorbital ecchymosis (black eye) AssessmentAssessment Management: ice, referral to Management: ice, referral to

ophthalmologist ophthalmologist Foreign bodiesForeign bodies

S&S: intense pain, tearingS&S: intense pain, tearing ManagementManagement

Not embedded: removal, inspectionNot embedded: removal, inspection Embedded: do not touch, activate EMSEmbedded: do not touch, activate EMS

Eye Conditions (cont.)Eye Conditions (cont.)

StySty Infection of sebaceous gland of Infection of sebaceous gland of

eyelash eyelash Starts as a red nodule; progresses into Starts as a red nodule; progresses into

a painful pustule a painful pustule Management: moist heat compressManagement: moist heat compress


Conjunctivitis (pink eye)Conjunctivitis (pink eye) S&S: itching, burning, watering, red S&S: itching, burning, watering, red

appearanceappearance Management: infectious; refer to physicianManagement: infectious; refer to physician

Corneal abrasionCorneal abrasion S&S: pain, tearing, photophobia, irritated with S&S: pain, tearing, photophobia, irritated with

blinking and eye movement, feeling of blinking and eye movement, feeling of ““something in the eyesomething in the eye””

Management: drops and eye patchManagement: drops and eye patch


Corneal lacerationCorneal laceration S&S: severe pain, decreased visual S&S: severe pain, decreased visual

acuityacuity Management: cover with no pressure, Management: cover with no pressure,

activate EMS, transport supine or activate EMS, transport supine or uprightupright


Subconjunctival Subconjunctival hemorrhagehemorrhage Rupture of small Rupture of small

capillaries; sclera capillaries; sclera appears red, blotchy, appears red, blotchy, inflamedinflamed

Requires no treatmentRequires no treatment Hyphema Hyphema

Caused by blunt traumaCaused by blunt trauma Hemorrhage into Hemorrhage into

anterior chamberanterior chamber Management: activation Management: activation

of EMSof EMS


Detached retinaDetached retina Can occur with or without traumaCan occur with or without trauma S&S: floaters and light flashesS&S: floaters and light flashes Management: patch both eyes; Management: patch both eyes;

refer to ophthalmologist refer to ophthalmologist


Orbital Orbital ““blowoutblowout”” fracture fracture Impact from a blunt object, usually larger than Impact from a blunt object, usually larger than

the eye orbit the eye orbit S&S:S&S:

DiplopiaDiplopia Numbness below eyeNumbness below eye Lack of eye movementLack of eye movement Recessed downward displacement of globeRecessed downward displacement of globe

Management: ice; immediate referral to Management: ice; immediate referral to physicianphysician

Eye Eye ““red flagsred flags””

Head and Facial Conditions. Anatomy of Head and Face Bones of skull Bones of skull Cranium Cranium...

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Transcript of Head and Facial Conditions. Anatomy of Head and Face Bones of skull Bones of skull Cranium Cranium...