Transcript Head and Face

CHAPTER 22
SCALP
 Scalp
 Skin
 Connective Tissue
 Apeneurosis
 Loose Connective Tissue
 Periosteum
CRANIUM
 Encases the brain
 Bones of the head
 Parietal (2)
 Temporal (2)
 Occipital (1)
 Sphenoid (1)
 Frontal (1)
 Ethmoid (1)
CRANIUM
 Bones of the face
 Nasal (2)
 Zygomatic (2)
 Maxilla (2)
 Mandible - jaw
MENINGES
 Between the skull and brain
 Covers the brain and spinal cord
 Three layers
1.
Dura mater – thick, dense, inelastic layer
1.
2.
3.
Epidural space – between skull and dura mater
Arachnoid – looks like spider web, delicate
Pia mater – thin, transparent, follows brain contour
Cerebrospinal Fluid
 Find it in Subarachnoid space
 Between arachnoid and the pia mater
 Function is to cushion the brain
BRAIN
 Cerebrum
 Coordinates voluntary
muscle activity
 Senses
 Higher mental functions

Memory, reasoning,
learning, judgement,
emotions
 Cerebellum
 Muscle movements
 Balance
BRAIN
 Pons
 Sleep
 Posture
 Breathing
 Swallowing
 Bladder
 Medulla Oblongata
 Heart rate
 Blood pressure
 Coughing and sneezing
 Vomiting
Head Injuries
 FYI: Damage done is not always proportional to the
blow to the head
 Same blow to two different people will can cause two
dramatically different injuries
Signs of a Worsening Head Injury
 Decreased level of consciousness
 More confused or irritable
 Persistent or increasing headache
 Decreased pulse
 Increased blood pressure
 Pupil irregularity
 Weakness in extremities
 Nausea, vomiting
 Anything you can say is not characteristic of
person
Skull Fracture
 MOI: VERY hard blow (ie, shot put, hammer, baseball bat)
 Can be obvious (depressed) or subtle (crack) fracture
 Signs and symptoms
 Rhinorrea: Discharge from nose – can be blood or cerebrospinal
fluid
 Otorrea: Discharge from ears – can be blood or cerebrospinal
fluid
Epidural Hematoma
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Epidural: Between the skull and the dura mater
Hematoma: collection of blood
Cause: hit to the head
Symptoms come about rapidly
They have a “Lucid Interval”:
 May show signs of getting better and then becomes
unconscious
 Will need surgery to relieve pressure in brain
Subdural Hematoma
 Subdural: below the dura mater, b/n the dura mater
and the arachnoid
 Cause: hit to the head
 Slower onset
 Acute: most common cause of death with head injury in
athletics (ie, boxing)
 Chronic: can take days or weeks for symptoms to manifest

Small amount of blood, and a membrane develops around it and it
increases in size over time
 Also surgically relieved
Concussion
 A traumatically induced alteration in mental status
not necessarily with a loss of consciousness
 Can happen from a directly or indirectly
 Directly: hit to the head
 Indirectly: hit to the body or whiplash
 Any athlete who shows signs or symptoms of a
concussion must be removed from play!
Concussion
 Signs and Symptoms
 Headache
 Dizziness
 Nausea
 Loss of consciousness
 Amnesia (memory loss)
 Inability to concentrate
 Vision problems
 Ringing in ears
 Emotional instability
 Fatigue
CONCUSSION
 Care
 REST – No activity – physical or mental
 Refer to doctor
 YOU SHOULD NEVER, NEVER PARTICIPATE IN
ANY PHYSICAL ACTIVITY WHILE YOU HAVE
SYMPTOMS OF A CONCUSSION!
SECOND IMPACT SYNDROME
 Rapid swelling of the brain that occurs when someone
sustains a second head injury before the previous head
injury has resolved.
 This can be a very minor injury (2nd one) that causes
major problems.
 This typically is fatal.
 Athlete must be rushed to hospital IMMEDIATELY.
Mandibular (Jaw) Fractures
 Cause: Direct blow, will usually fracture at the angle
 S/S
 Will be unable to fully open and close mouth
 Malocclusion: unable to bring teeth together
 Possible bleeding at base of teeth
 May have numbness in low lip
 May have multiple fractures
 Care: Immobilize, jaw wired shut for 4-6 weeks
Nasal Fracture
 Cause: Direct blow
 May or may not be displaced
 Care
 Control bleeding – do not put anything up nose
 Ice
 Refer to MD
Epitaxis (Nose bleed)
 Cause: can be many things
 Hit to the nose
 Dry air
 Control by sitting upright, head forward, gauze at
nostrils and apply pressure at bridge of nose
 Do not remove gauze if bloody, just apply fresh gauze
around it
Cauliflower Ear
 Skin in upper ear separates from cartilage and it fills
with blood
 Wrestling – ear sticks to mat
 Will harden if left untreated – permanent deformity
 MD can drain it if caught early on
SWIMMER’S EAR (Otitis Externa)
 Infection of the ear canal
 S/S
 Ear pain
 Dizziness
 Ear itches
 Discharge from ear
 Care
 Refer to MD, rule out ear drum rupture
 Antibiotics
Corneal Abrasion
 Cause: Poked in the eye
 Will feel like something is in the eye
 Eye may tear up
 Can be painful, may not want to open eye
 If no relief from eyewash, see MD
Periorbital Hematoma

Black Eye – no big deal, right?
 Eye symptoms to worry about
 Blurred and/or double vision
 Spotty vision
 Pain
 Blood in the eye
Blow Out Fracture
 Fracture of the orbit of the eye
 Cause: Direct hit to the eye
 Usually it is the floor of the eye that fractures
 Limits movement – cannot look up
 May have double vision (diplopia)
 Immediate referral to MD
Tooth displacement and avulsion
 Cause: direct hit to mouth
 If found keep the tooth
 If it is still in place somewhat, leave it there
 Otherwise, in sterile saline or milk
 Immediate referral to dentist – two hour window for
re-implantation