Sports Medicine: Just the Facts

166 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE

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29 OTORHINOLARYNGOLOGY

Charles W Webb, DO

INTRODUCTION

•Facial injuries are among the most common injuries
in athletics. They comprise 4–19% of all sports
related injuries depending on age and gender. One-
third of all dental injuries are sports related (Truman
et al, 2002). In the pediatric age ranges, one-third of
injuries are sports related (Luke and Micheli, 1999).
The gender difference increases with age from 1.5:1
male to females during the ages of 1–10 years, to
12:1 in the 16–18 year olds (Truman et al, 2002;
Shaikh and Worrall, 2002). With the addition of face-
masks and mouth guards in football and hockey
(1950s and 1970s respectively), the number of severe
facial injuries has declined dramatically (Hart, 2002).
Baseball now accounts for the majority (40%) of all
sports related facial injuries in the United States.

ASSESSMENT OF INJURIES ON THE SIDELINE

• Sideline management of the athlete with a facial injury
  begins with the ABCs (airway, breathing, circulation).

Blood, avulsed teeth, mouth guards, or other objects

are airway hazards. Cervical spine precautions must

be observed in all head injuries, especially when the

player is unconscious.

• The history should include the mechanism of injury,
  and the presence of any other injuries past or present.
  An important question to ask is, “Does it feel the same
  when you (the athlete) bite down?” If not, then there
  is a question of mandibular dislocation, fracture, or
  tooth injury (Douglass and Douglass, 2003).
  •Physical examination includes observation, palpation,
  and imaging (if there is any question about the diag-
  nosis). Observation includes evaluation of facial sym-
  metry, bruising, and swelling. Palpation includes the
  orbital rim, nasal bones, maxillary bones, mandible,
  temporal mandibular joint, and the upper and lower
  jaws intra- and extraorally.


• The nares should be inspected for any type of fluid
  drainage. This may be blood or cerebral spinal fluid
  (CSF). The “ring test” is a method of detecting CSF
  on the sideline. It is done by placing a drop of blood
  from the nares on a piece of paper or gauze, CSF will
  form a halo (clear fluid ring) around the drop of
  blood. This represents a severe facial fracture and
  requires immediate transport.


• Imaging is usually of limited value. X-rays may be help-
  ful in determining the presence of a facial fracture; how-
  ever, computed tomography(CT) is the gold standard.


• Return to play guidance is based on the history and
  physical examination. Suspected fractures, airway
  obstruction or impending obstruction, bleeding, loss
  of consciousness, and changes in vision are con-
  traindications for return to play.

EAR INJURIES

EAR LACERATION

• Signs and symptoms:Pain and bleeding around the
  ear with history of trauma.


• Examination:Must evaluate for cartilage involve-
  ment and for radial extension to the scalp.


• Treatment:Cartilage tear, repair with absorbable 5-O
  suture prior to closing the skin. Laceration should be
  irrigated and debrided prior to suturing. Prophylactic
  antibiotics are recommended to prevent chondritis.

AURICULAR HEMATOMA

• “Wrestler’s Ear” or “Cauliflower Ear” is caused by
  bleeding between the skin (perchondrium) and the
  auricular cartilage. This occurs secondary to repetitive