Treatment of nasal fracture by Paul of Aegina

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Slide 1 :

Jeffrey S. Fichera MS PA-C The Ear, Nose, Throat and Plastic Surgery Assoc. Inc.

Slide 2 :

Facial Injuries in Sports The Athletic Trainer must be prepaired to manage facial injuries, including Contusions Abrasions Laserations Nasal fractures

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Facial Injuries in Sports Septal hematomas Auricular hematoms Ruptured tympanic membranes Fractures of the facial bones

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Sports Acitivies Account for 3% to 29% of all facial injuries Approx. 10% to 42% of all facial fractures 60% to 90% of injures occur in male participants between 10 and 29 years old.

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Mechanism of Injury Direct Impact – with another players body part (eg, head, fist, elbow) Equipment (eg, ball, puck, goalpost, handlebars ) The Ground ( eg, wrestling mat, gym floor) Enviroment ( eg, tree, outfield wall )

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Return-to-Play Treament requires knowledge of the injury Type and serverity of injury Physicial demands of the sport

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Initial Exam and Evaluation Pertinent History Physicial Exam Remember the “ WOW FACTOR ”

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Soft-Tissue Injuries Contusions Abrasions Lacerations

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Contusions Most commonly encountered facial injury Results from blunt trauma to the face Treatment aimed at minimizing inflammatory response ( ice, nonsteroidals)

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Abraisions Partial-thickness disruptions of the epidermas Commonly results from blunt trauma or sudden forcible friction Always consider underlying injury 40% of all Tetanus (1998-2000) resulted from abrasions and lacerations

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Nasal Injuries Epistaxis Septal Hematoma Fracture

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Epistaxis 80% of all nose bleeds are from the anterior source ( ie. Kiesselbach’s Plexus ) 20% are posterior and usually a disease of the middle aged and elderly

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Nasal Blood Supply Why the WOW FACTOR? External Carotid Facial artery ( 2 branchs ant. Septum, ala ) Internal maxillary ( most important ) Terminal branch of EC gives rise to Sphenopalatine Nasopaltine Greater palatine

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Nasal Blood Supply Internal Carotid Opthalmic artery Anterior and Posterior ethmoid artery

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Nasal Blood Supply

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EPISTAXIS Cosider nasal fracture as source of epistaxis. Athlete may report having heard a “crunch” or “crack”. Nasal fractures are diagnosed clinically.

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Focus of Initial Treatment Hemostasis Minimizing swelling Treatment of Nasal Fracture Ice and Pain control Aspirin contraindicated Nasal decongestants for up to 3 days Nasal fractures are reduced or refered to ENT in 3 – 5 days.

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Anterior Epistaxis Best controlled by slightly reclining the patient and applying direct pressure to the nasal septum for 5 to 10 min. Apply ice to the back of the neck may help by causing reflex vasoconstriction

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Persistent Epistaxis Occasionally requires nasal packing with: Mericel Sponge Topical Antibiotic Topical Coagulant FloSeal May use phenylephrine hydrochloride or oxymetazoline hydrochloride for vasoconstriction

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Return to Play Can be immediate if bleeding is controlled. Custom face shields, helmets with face masks, or protective devices should be worn for 4 weeks after injury. Noncontact sports, return to play can be immediate if hemostasis controlled.

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Nasal Fracture

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Complications from Nasal Fracture Chronic nasal obstruction Deviated septum Septal hematoma Must Rule Out

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Septal Hematoma Bulging bluish mass Genarally form within hours after injury Requires prompt I&D, nasal pack and antibiotics Must refer to ENT if present

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Nasal Fracture

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Septal Deviation

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Ear Injuries Contusions caused by shearing forces applied to the external ear are common. Most common in wrestling. Mechanism of injury is blunt trauma against the wrestling mat. RESULT = AURICULAR HEMATOMA

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The External Ear

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Auricular Hematoma Diagnosis established by early Ecchymosis Erythema and pain Palpable collection of fluid Swelling of external ear with loss of anatomical landmarks

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Auricular Hematoma

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Early Treatment Ice apllied eary with continued compression can minimize the risk of developing an auricular hematoma. If hematoma present – prompt aspiration required

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Treatment Options Aspiration with 18 or 20-gauge needle Incision and Drainage using sterile technique Compression applied for 7 to 14 days Dental roll with through & through sutures. Antibiotics for 7 – 10 dayes recommended Cephalosporins

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Auricular Hematoma I & D Evacuation of hematoma

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Auricular Hematoma Dental Roll Application

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Auricular Hematoma

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Auricular Hematoma

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Return to Play Noncontact sports may return to play immediately Contact sports require ear protection and athletes may return to play 48 hours after dental rolls are removed.

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Complications Pressure necrosis of the underlying cartilage by seperating the perichondrial blood supply from the underlying cartilage, results in CAULIFLOWER EAR.

Slide 38 :

Cauliflower Ear

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Tympanic Membrane Perforation Most common Cause – pressure caused from OM Blunt trauma – Barotrauma Swimming, diving, highaltitude changes, direct contact to the ear

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TM Anatomy

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Normal TM

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TM Perforation

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TM Perforation

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TM Perforation

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TM Perforation Symptoms May be Asymptomatic or Hearing loss Vertigo Bloody or serous discharge Discomfort worsened by wind or cold

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Diagnosis Always consider if mechanism of injury present. Otoscopic evaluation

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Treatment Keep ear canal dry ENT evaluation Audiogram Otic drops may be required Return to play will depend on sport and symptoms

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Facial Fractures 75 % of facial fractures occur in the: Mandable Zygoma Nose All Facial Fractures Require Referal

Slide 49 :

Diagnosis

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Diagnosis

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Diagnosis

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Diagnosis

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Questions ?

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