chapter 22. scalp scalp skin connective tissue apeneurosis loose connective tissue periosteum

HEAD AND FACECHAPTER 22

ANATOMY

SCALPScalp

SkinConnective TissueApeneurosisLoose Connective

TissuePeriosteum

CRANIUMEncases the brainBones of the head

Parietal (2)Temporal (2)Occipital (1)Sphenoid (1)Frontal (1)Ethmoid (1)

CRANIUMBones of the face

Nasal (2)Zygomatic (2)Maxilla (2)Mandible - jaw

MENINGESBetween the skull and brainCovers the brain and spinal cordThree layers

1. Dura mater – thick, dense, inelastic layer1. Epidural space – between skull and dura mater

2. Arachnoid – looks like spider web, delicate3. Pia mater – thin, transparent, follows brain contour

Cerebrospinal FluidFind it in Subarachnoid space

Between arachnoid and the pia materFunction is to cushion the brain

BRAINCerebrum

Coordinates voluntary muscle activity

SensesHigher mental

functions Memory, reasoning,

learning, judgement, emotions

CerebellumMuscle movementsBalance

BRAINPons

SleepPostureBreathingSwallowingBladder

Medulla OblongataHeart rateBlood pressureCoughing and sneezingVomiting

HEAD INJURIES

Head InjuriesFYI: Damage done is not always proportional

to the blow to the headSame blow to two different people will can

cause two dramatically different injuries

Signs of a Worsening Head InjuryDecreased level of consciousnessMore confused or irritablePersistent or increasing headacheDecreased pulseIncreased blood pressurePupil irregularityWeakness in extremitiesNausea, vomitingAnything you can say is not characteristic

of person

Skull FractureMOI: VERY hard blow (ie, shot put, hammer,

baseball bat)Can be obvious (depressed) or subtle (crack)

fractureSigns and symptoms

Rhinorrea: Discharge from nose – can be blood or cerebrospinal fluid

Otorrea: Discharge from ears – can be blood or cerebrospinal fluid

Epidural HematomaEpidural: Between the skull and the dura

mater Hematoma: collection of bloodCause: hit to the headSymptoms come about rapidlyThey have a “Lucid Interval”:

May show signs of getting better and then becomes unconscious

Will need surgery to relieve pressure in brain

Subdural HematomaSubdural: below the dura mater, b/n the dura

mater and the arachnoidCause: hit to the headSlower 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

ConcussionA traumatically induced alteration in mental

status not necessarily with a loss of consciousness

Can happen from a directly or indirectlyDirectly: hit to the headIndirectly: hit to the body or whiplash

Any athlete who shows signs or symptoms of a concussion must be removed from play!

ConcussionSigns and Symptoms

HeadacheDizzinessNauseaLoss of consciousnessAmnesia (memory loss)Inability to concentrateVision problemsRinging in earsEmotional instabilityFatigue

CONCUSSIONCare

REST – No activity – physical or mentalRefer to doctor

YOU SHOULD NEVER, NEVER PARTICIPATE IN ANY PHYSICAL ACTIVITY WHILE YOU HAVE SYMPTOMS OF A CONCUSSION!

SECOND IMPACT SYNDROMERapid 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.

FACIAL INJURIES

Mandibular (Jaw) FracturesCause: Direct blow, will usually fracture at

the angleS/S

Will be unable to fully open and close mouthMalocclusion: unable to bring teeth togetherPossible bleeding at base of teethMay have numbness in low lipMay have multiple fractures

Care: Immobilize, jaw wired shut for 4-6 weeks

Nasal FractureCause: Direct blowMay or may not be displacedCare

Control bleeding – do not put anything up noseIceRefer to MD

Epitaxis (Nose bleed)Cause: can be many things

Hit to the noseDry 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 EarSkin in upper ear separates from cartilage

and it fills with bloodWrestling – 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 canalS/S

Ear pain DizzinessEar itchesDischarge from ear

CareRefer to MD, rule out ear drum ruptureAntibiotics

Corneal AbrasionCause: Poked in the eyeWill feel like something is in the eyeEye may tear upCan be painful, may not want to open eyeIf no relief from eyewash, see MD

Periorbital Hematoma Black Eye – no big deal, right?

Eye symptoms to worry aboutBlurred and/or double visionSpotty visionPainBlood in the eye

Blow Out FractureFracture of the orbit of the eyeCause: Direct hit to the eyeUsually it is the floor of the eye that fracturesLimits movement – cannot look upMay have double vision (diplopia)Immediate referral to MD

Tooth displacement and avulsionCause: direct hit to mouthIf found keep the tooth

If it is still in place somewhat, leave it thereOtherwise, in sterile saline or milk

Immediate referral to dentist – two hour window for re-implantation