facial lacerations at ringside · 2018. 4. 1. · motor branches of the facial nerve – cn vii car...

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FACIALLACERATIONSATRINGSIDE

USABOXING-MEDICALHANDBOOKandMEDICALRULESofAIBAOPENBOXING-AsadaptedforuseintheUnitedStatesfromthe2013AIBAEdiLon

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MEDSCHOOLANATOMY

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SurfaceAnatomyoftheFace

Nasolabial Fold

Submandibular Gland

Mandible

Mental Protuberance

Philtrum of Superior Lip (Labia)

Buccal region Vermilion Border

Nares

Labial Commisure

Parotid

Infraorbital Margin

Zygoma

Orbit

Pinna

Supraorbital Ridge

Submental Region

MajorStructuresoftheSuperficialFace•  Eye,noseandpieholes•  MusclesofFacial

Expression

•  ParoLdglandandduct•  Branchesofthefacial

nerve

•  Branchesofthetrigeminalnerve

•  Facialarteryandthesuperficialtemporalartery

•  Veinsdrainingtotheinternalandexternaljugularveins

DissecLonoftheSuperficialFaceSuperficial Temporal A&V

Greater Auricular N

External Jugular V

Sterno

masto

id M

Mentalis M. Facial A&V Platysma M.

Parotid Gland

Parotid Duct

Transverse Facial A

Buccinator

Zygomaticus Major

Orbicularis Oculi

Branches of the facial N

Auriculotemporal N

ArteriestotheFace

Facial Artery is anterior to the Facial

V, in front of Masseter M.

Superficial Temporal A

Anterior Branch

Posterior Branch

Transverse Facial A.

Facial Artery

Angular ArterySuperior Labial

Artery

Inferior Labial Artery

There would also be a supra- and infra-

orbital arteries, lacrimal artery and a few other small ones.

Lingual Artery

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Cranial Cavity Orbit

Pterygoid Plexus

Cavernous Sinus

CranialNervesAssociatedWiththeFace•  TrigeminalNerve

– Sensorytotheskin– Threedivisions

•  FacialNerve– MotortoMusclesofFacialExpression

– LacrimalandallSalivarySecreLons(Except1)

•  GlossopharyngealNerve– ParoLdSecreLons

MotorBranchesoftheFacialNerve–CNVII

Car - Cervical

To – Temporal (Frontal)

(Top of Orbic Oculi)

Zanzibar – Zygomatic (Bottom of Orbic Oculi)

By – Buccal (Top of Orbic Oris)

Motor – Mandibular (Bottom of Orbic Oris) Exits Stylomastoid Foramen

Posterior Auricular

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USABOXINGMANUAL

RINGSIDEPRACTICE

THISWASTHESTANDARD

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UpdatedImage

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ADEEPCUTNEARTHESE6HOLESISDANGEROUS

TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace THEYALLLINEUP

WTHEPUPIL

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DANGEROUSIFDEEP!

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DANGEROUSIFDEEP!

90%OFALLLACS

ABSOLUTEInjuriesAroundtheEyes:

TarsalPlatesandNasolacrimalDuct

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Injuriesthatincludetheeye/obscurevision

EyebyEscher,1946

!  Thebasicprincipleofhandlingcutsaroundtheeyeisthat,ifacutcausesenoughbleedingtoimpairvision,theboutshouldbestopped.

!  MostcutswillNOTrequirethattheboutbestopped.

SHOWSTOPPER?

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DANGEROUSIFDEEP!

UpdatedImage

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SummeryofFacialLaceraLons SummaryofZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

SummaryofZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

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PressurePointstoStopBleeding

SuperficialTemporalArtery

TransverseFacialArtery

AngularArtery

FacialArtery

SuperiorLabialArtery

InferiorLabialArtery

LaceraLonZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

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LaceraLonZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

LARRYLOVELACE,DO,FACEP,DABEM,DABFM,DABFE,ACSM/ARP

RINGSIDEARP.ORG

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DANGEROUSIFDEEP!

DANGEROUSIFDEEP!

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TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace

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TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace

TrigeminalMajorPorLonsSuppliesCutaneousNervesoftheFace PressurePointstoStopBleeding

SuperficialTemporalArtery

TransverseFacialArtery

AngularArtery

FacialArtery

SuperiorLabialArtery

InferiorLabialArtery

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Superficial Temporal A

Transverse Facial A.

InjuriesoftheFace

5.3.1.Occasionallyacutwillbeinanareawheredeepstructuresmaybeinjured.Inboxing,asthesearebluntinjuriesandnotsharpinjuries,itissLllunusualtohavetostopaboutunlesstheselaceraLonsarequitedeepandsevere.However,thefollowinglaceraLonsshouldbeevaluatedwiththisinmind.

BlowoutofOrbitHitintheeye(blackorswolleneye)Andeitherorbothofthe

nexttwo–  Numbnesstowardupperteeth–  Doublevisiononupwardgaze

Answer!Theflooroftheorbitisblown!

–  Infraorbitalnerveisinterrupted–  InferiorRectusmaybeentrapped

AnteriorCranialFossa

Orbit

MaxillarySinus

MRIofFace

InjuriesaroundtheEyeSupraorbital/Supratrochlear

This muscle is superficial to the nerve and artery so that a cut in this region would have to be very deep to injure the nerve

and artery

InjuriesaroundtheEye–InfraorbitalNerveandArtery

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FacialNerve Video

LaceraLonsovermedialeye5.3.1.1.2.Cutsmediallyoverthelarcrimalductareamayextendintothenasolachrymalduct.

LaceraLonstotheeyelid

5.3.1.1.4.Cutsontheeyeliditselfcoulddamagethetarsalplateortheglobeitselfmayhavebeeninjured.

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LaceraLonsofthelip5.3.1.1.5.VerLcalcutsthroughthevermillionborderofthelipshouldstoptheboutbecauseofthepotenLalforfurthertearingofthelipfromsubsequenttrauma.

CutsovertheEye5.3.1.1.1.Cutsoverthesupraorbitalnerveorthesupratrochlearnerve,iftheyaredeepenough,maydamagethenerve.

LaceraLoninferiortotheeye

5.3.1.1.3.Cutsovertheinfraorbitalnerve,ifdeepenough,coulddamagethenerve.

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ResponsibiliLesforLaceraLonsThephysicianmustbepreparedtoevaluatecutsatringside.Thebasicprincipleofhandlingcutsaroundtheeyeisthat,ifacutcausesenoughbleedingtoimpairvision,theboutshouldbestopped.MostcutswillNOTrequirethattheboutbestopped.

Cutsaroundoronthebridgeofthenose AnteriorNoseBleed•  Mostnosebleedwillbeanteriorandintheabsenceoffractureself-limiLng

•  Inanynosebleeditisimportanttolookdownthethroat

•  IfthereisonlyalinlebloodinthepharynxitisprobablyananteriorBleed

•  Mostnosebleedswillstopontheirownorwithexternalpressure.

•  Amessynosebleedisnotnecessarilyaseriousnosebleed

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PosteriorNoseBleeds•  DeterminaLonofposteriorbleedingshouldalsobedonebytonguedepressionandpenlightobservaLon.

•  Brightbloodintheoralpharynx–behindtheposteriorpillarisaclearsignofaposteriorbleed

•  Ifthereareclotsinthepharynxortheboxerisspiongclots,theboutshouldbestopped

•  Mostnosebleedswillstopontheirownorwithexternalpressure.

•  Amessynosebleedisnotnecessarilyaseriousnosebleed

WhatcanbedoneabouttheLaceraLon

5.3.3.Nodressingofcutsisallowedexceptforcollodionorsteristrips.SubcuLcularclosureofcertaincutswithacoveringofcollodionorsteristripsmayallowwinningboxerstoconLnueinatournament.Iftheychoosethisapproach,theyshouldbemadeawarethatthereisariskthatthewoundmayreopenduringtheboutandrequirefurtherrepairaperthebout.Itcouldbebadenoughifitreopenstoterminatethebout.Itcouldcausefurtherdamage.

Howtohandlenosebleeds5.4.1.TheiniLalevaluaLonshoulddeterminethepresenceofafracture.Gentlehandlingofanosebleedisnecessarysoasnottofurtheraggravateorcompoundafracture.5.4.2.Ifnofractureisfelt,thephysicianmustthenevaluatethecharacterofthebleeding(i.e.venousvs.briskarterialgushing).Boutsarestoppedforarterialbleeding(rareinthissituaLon).5.4.3.DeterminaLonofposteriorbleedingshouldalsobedonebytonguedepressionandpenlightobservaLon.Ifthereareclotsintheposteriorpharynxortheboxerisspiongclots,theboutshouldbestopped.5.4.4.Massivevenousbleedingmaybecausetostopabout.5.4.5.Nosebleedsshouldstopboutsformedicalreasons.Mostnosebleedswillstopontheirownorwithexternalpressure.Amessynosebleedisnotnecessarilyaseriousnosebleed.5.4.6.ThedoctormayalsostoptheboutiftheboxerdoesnotwanttoconLnueorinyoungboxerswheretheexperiencecanbefrightening.

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SummaryofZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

SummaryofZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

SummaryofZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

LaceraLonZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

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LaceraLonZones

LarryLovelace,DO,FACEP&DanielO’Donoghue,PA-C,PhD

PressurePointstoStopBleeding

SuperficialTemporalArtery

TransverseFacialArtery

AngularArtery

FacialArtery

SuperiorLabialArtery

InferiorLabialArtery

PressurePointstoStopBleeding

SuperficialTemporalArtery

TransverseFacialArtery

AngularArtery

FacialArtery

SuperiorLabialArtery

InferiorLabialArtery

PressurePointstoStopBleeding

SuperficialTemporalArtery

TransverseFacialArtery

AngularArtery

FacialArtery

SuperiorLabialArtery

InferiorLabialArtery