Head and Facial ConditionsHead and Facial Conditions

Chapter 8Chapter 8

AnatomyAnatomy

• BonesBones• ScalpScalp• BrainBrain• EyesEyes• NervesNerves• Blood SupplyBlood Supply

BonesBones

• FrontalFrontal• OccipitalOccipital• TemporalTemporal• MaxillaMaxilla• ZygomaticZygomatic• PalatinePalatine• NasalNasal

• LacrimalLacrimal• VomerVomer• Nasal ConchaNasal Concha

ScalpScalp

• SkinSkin• Subcutaneous connective tissueSubcutaneous connective tissue• PericardiumPericardium

BrainBrain

• Cerebral hemispheresCerebral hemispheres• DiencephalonsDiencephalons• Brain stemBrain stem• CerebellumCerebellum• MeningesMeninges

– Dura materDura mater– Arachnoid materArachnoid mater– Pia materPia mater

EyesEyes

• Lacrimal glandsLacrimal glands• ScleraSclera• CorneaCornea• ChoroidChoroid• RetinaRetina

NervesNerves

• I OlfactoryI Olfactory• II OpticII Optic• III OculomotorIII Oculomotor• IV TrochlearIV Trochlear• V TrigeminalV Trigeminal• VI AbducensVI Abducens

• VII FacialVII Facial• VIII Vestibulo-VIII Vestibulo-

cochlearcochlear• IX Glosso-IX Glosso-

pharyngealpharyngeal• X VagusX Vagus• XI AccessoryXI Accessory• XII HypoglossalXII Hypoglossal

Skull FracturesSkull Fractures

• LinearLinear• ComminutedComminuted• DepressedDepressed• BasilarBasilar• Raccoon EyesRaccoon Eyes• Battle’s SignBattle’s Sign• Loss of Smell or SightLoss of Smell or Sight• Blood or CSF leaking from ears or noseBlood or CSF leaking from ears or nose

Focal Cerebral InjuriesFocal Cerebral Injuries

• Localized collection of blood or Localized collection of blood or hematoma.hematoma.

• Increases pressure on the brain.Increases pressure on the brain.• Epidural or SubduralEpidural or Subdural

Epidural HematomaEpidural Hematoma

• Outside the dura materOutside the dura mater• Direct blow to the side of the head Direct blow to the side of the head

usually causing a fracture.usually causing a fracture.• LOCLOC• Lucid interval Lucid interval Decline in mental status Decline in mental status• Headache, nausea, vomiting, - level of Headache, nausea, vomiting, - level of

consciousness, dilated pupil, contra consciousness, dilated pupil, contra lateral weakness, and decerebrate lateral weakness, and decerebrate posture.posture.

Subdural HematomaSubdural Hematoma

• Hemorrhaging beneath the dura materHemorrhaging beneath the dura mater• S&S may not be evident for days or S&S may not be evident for days or

even weeks after injuryeven weeks after injury• Severe headache, nausea or vomiting, Severe headache, nausea or vomiting,

pupil irregularity, confusion, + BP, - HR, pupil irregularity, confusion, + BP, - HR, Irregular breathing and eye movements, Irregular breathing and eye movements, + body temperature, and a change in + body temperature, and a change in emotional control.emotional control.

Cerebral ContusionCerebral Contusion

• ConcussionConcussion• Posttraumatic HeadachesPosttraumatic Headaches• Secondary impact syndromeSecondary impact syndrome

ConcussionsConcussions

• Grade IGrade I• Grade IIGrade II• Grade IIIGrade III• CantuCantu• TorgTorg• ColoradoColorado• American Academy of NeurologyAmerican Academy of Neurology

Grade IGrade I

• No loss of consciousness (LOC)No loss of consciousness (LOC)• Brief period of confusionBrief period of confusion• Symptoms last less than 15 Symptoms last less than 15

minutesminutes• Return to play guidelinesReturn to play guidelines

Grade IIGrade II

• No LOCNo LOC• Transient confusionTransient confusion• Symptoms lasting more than 15 Symptoms lasting more than 15

minutesminutes• Retrograde amnesiaRetrograde amnesia• Anterograde amnesiaAnterograde amnesia• Return to play guidelinesReturn to play guidelines

Grade IIIGrade III

• LOC of seconds or minutesLOC of seconds or minutes• DecorticationDecortication• DecerebrationDecerebration• ConvulsionsConvulsions• Return to play guidelinesReturn to play guidelines

Posttraumatic HeadachesPosttraumatic Headaches

• Easily confused with concussionsEasily confused with concussions• Localized area of blindnessLocalized area of blindness• Brilliantly colored lightsBrilliantly colored lights

Postconcussion SyndromePostconcussion Syndrome

• Develops after a concussionDevelops after a concussion• Persistent headachesPersistent headaches• Blurred visionBlurred vision• VertigoVertigo• Memory lossMemory loss• IrritabilityIrritability• Inability to concentrateInability to concentrate

Secondary Impact Secondary Impact SyndromeSyndrome

• Concussed individual gets a second Concussed individual gets a second concussionconcussion

• Rapidly dilating pupilsRapidly dilating pupils• Loss of eye movementLoss of eye movement• Coma Coma • Respiratory failureRespiratory failure

Scalp InjuriesScalp Injuries

• Control bleedingControl bleeding• Prevent contaminationPrevent contamination• Rule out skull fractureRule out skull fracture

Cranial InjuriesCranial Injuries

• Vital SignsVital Signs– PulsePulse– RespirationRespiration– Blood PressureBlood Pressure

History and Mental Status History and Mental Status TestingTesting

• Distractibility, stream of thought, Distractibility, stream of thought, goal-directed movementsgoal-directed movements

• OrientationOrientation• ConcentrationConcentration• MemoryMemory• SymptomsSymptoms• Loss of consciousnessLoss of consciousness

Observation and Observation and InspectionInspection

• Leakage of cerebrospinal fluidLeakage of cerebrospinal fluid• Signs of traumaSigns of trauma• Skin colorSkin color• Loss of emotional controlLoss of emotional control

PalpationPalpation

• Scalp and hairScalp and hair• Cervical spinous processesCervical spinous processes• Base of skullBase of skull• Frontal bone, eye orbit, bridge of Frontal bone, eye orbit, bridge of

the nosethe nose• Zygomatic archZygomatic arch• Upper and lower jawUpper and lower jaw

Neurologic ExaminationNeurologic Examination

• Cranial Nerve assessmentCranial Nerve assessment• Pupil abnormalitiesPupil abnormalities• Babinski’s reflexBabinski’s reflex• StrengthStrength• CoordinationCoordination• Sensation and balanceSensation and balance• External provocationExternal provocation

Facial conditionsFacial conditions

• Facial soft tissue injuriesFacial soft tissue injuries– Treat same as rest of bodyTreat same as rest of body– Steri-strip if larger than thumbSteri-strip if larger than thumb

Temporomandibular JointTemporomandibular Joint

• Hit in jawHit in jaw– MalocclusionMalocclusion– Joint noiseJoint noise– Inability to close mouthInability to close mouth

Zygomatic FracturesZygomatic Fractures

Mandibular FracturesMandibular Fractures

Maxillary FracturesMaxillary Fractures

Nasal conditionsNasal conditions

• EpistaxisEpistaxis• Nasal FracturesNasal Fractures

Oral and Dental ConditionsOral and Dental Conditions

• Mouth lacerationsMouth lacerations• Fractured toothFractured tooth• Dislocated toothDislocated tooth

Ear ConditionsEar Conditions

• External ear injuryExternal ear injury• Internal ear injuryInternal ear injury• Swimmers earSwimmers ear

Eye conditionsEye conditions

• Periorbital Periorbital EcchymosisEcchymosis

• Foreign bodiesForeign bodies• StySty• ConjunctivitisConjunctivitis• Corneal abrasionCorneal abrasion• Corneal Corneal

LacerationLaceration

• Subconjunctival Subconjunctival HemorrhageHemorrhage

• Hemorrhage of Hemorrhage of the anterior the anterior chamberchamber

• Detached retinaDetached retina• Orbital BlowoutOrbital Blowout• Displaced contact Displaced contact

lenslens