eMedicine Specialties > Sports Medicine > Face and Head

Facial Fractures: Follow-up

Author: Timothy J Rupp, MD, FACEP, Associate Medical Director, Physicians Emergency Care Associates, Methodist Health System, Dallas, Texas; Staff Physician, Innovative Emergency Medicine, Frisco, Texas; Staff Physician, Department of Emergency Medicine, Children's Medical Center of Dallas, Dallas, Texas
Coauthor(s): Steven Karageanes, DO, Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System
Contributor Information and Disclosures

Updated: Mar 14, 2008

Follow-up

Return to Play

In fractures that involve or approximate the eye, visual acuity is the most important factor in return to play. Any unexplained loss of acuity needs a complete workup. The aforementioned 20/40 criteria to play still apply (see Sport-Specific Biomechanics). Any athlete returning to competition without complete bone healing needs adequate protection, such as a full face shield, modified batting helmets, extended hockey eye visors, or larger football face masks.

Athletes need to regain their confidence in returning to play. An athlete who has physically recovered may not be mentally recovered from the trauma of the injury and, thus, is at risk of further injury. This is often observed in baseball players hit in the face by a pitch or hit ball. Psychologic recovery from facial fractures can be assessed in controlled practice situations. A consultation with a sports psychologist may be necessary if difficulties linger.

Return-to-play recommendations are not affected after orofacial fractures.12 In a report by Laskin, the author observed that more than 100,000 sport-related injuries could be prevented annually by wearing appropriate head and face protection.4

Related Medscape topics:
Resource Center Adolescent Medicine
Resource Center Exercise and Sports Medicine
Resource Center Trauma

Prevention

Adherence to the rules and guidelines established by the specific sports governing body is most important. Almost all eye injuries are preventable, but other fractures can and do occur in sports with high levels of physical contact. Visual acuity, protective gear, and adherence to the rules of the sport are the best ways to limit the risk of facial fractures.

Education

Miscellaneous

Medicolegal Pitfalls

  • Airway management in patients with facial injuries should be aggressive. Subsequent bleeding and edema can result in airway obstruction. This should be taken into account, especially if a patient requires transfer. CT scans are the studies of choice. If the clinical suspicion for airway obstruction is high and plain radiographs are negative, then a CT scan should be obtained.
  • CNS and ophthalmologic injuries can have dire consequences if missed or detected too late. Perform thorough neurologic and eye examinations and consult specialists early.

Related Medscape topics:
Resource Center Medical Malpractice and Legal Issues
Resource Center Resuscitation
Resource Center Trauma

 


More on Facial Fractures

Overview: Facial Fractures
Differential Diagnoses & Workup: Facial Fractures
Treatment & Medication: Facial Fractures
Follow-up: Facial Fractures
Multimedia: Facial Fractures
References
[ CLOSE WINDOW ]

References

  1. Costello BJ, Papadopoulos H, Ruiz R. Pediatric craniomaxillofacial trauma. Clin Pediatr Emerg Med. 2005;6(1):32-40.

  2. Boden BP, Tacchetti R, Mueller FO. Catastrophic injuries in high school and college baseball players. Am J Sports Med. Jul-Aug 2004;32(5):1189-96. [Medline].

  3. Schulz RC. Facial Injuries. 2nd ed. Chicago, Ill: Yearbook Medical Publishers, Inc; 1977.

  4. Laskin DM. Protecting the faces of America. J Oral Maxillofac Surg. Apr 2000;58(4):363. [Medline].

  5. Romeo SJ, Hawley CJ, Romeo MW, Romeo JP. Facial injuries in sports: a team physician's guide to diagnosis and treatment. Phys Sportsmed. Apr 2005;33(4):45-53. [Full Text].

  6. Tanaka N, Hayashi S, Suzuki K, et al. [Clinical study of maxillofacial fractures sustained during sports and games] [Japanese]. Kokubyo Gakkai Zasshi. Sep 1992;59(3):571-7. [Medline].

  7. Iida S, Kogo M, Sugiura T, Mima T, Matsuya T. Retrospective analysis of 1502 patients with facial fractures. Int J Oral Maxillofac Surg. Aug 2001;30(4):286-90. [Medline].

  8. Bak MJ, Doerr TD. Craniomaxillofacial fractures during recreational baseball and softball. J Oral Maxillofac Surg. Oct 2004;62(10):1209-12. [Medline].

  9. Reyes Mendez D, Lapointe A. Nasal trauma and fractures in children. UpToDate [serial online]. May 2007;Accessed September 14, 2007. Available at www.UpToDate.com.

  10. Neuman MI, Bachur RG. Orbital fractures. UpToDate [serial online]. September 2006;Accessed September 14, 2007. Available at www.UpToDate.com.

  11. Schwab RA, Genners K, Robinson WA. Clinical predictors of mandibular fractures. Am J Emerg Med. May 1998;16(3):304-5. [Medline].

  12. Tesini DA, Soporowski NJ. Epidemiology of orofacial sports-related injuries. Dent Clin North Am. Jan 2000;44(1):1-18, v. [Medline].

  13. Baker SM, Hurwitz JJ. Sports and industrial ophthalmology: management of orbital and ocular adnexal trauma. Ophthalmol Clin North Am. 1999;12:435-55.

  14. Christensen GR. Eye injuries in sports: evaluation, management, and prevention. In: Mellion MB, Walsh WM, Shelton GL, eds. The Team Physician's Handbook. 2nd ed. Philadelphia, Pa: Hanley & Belfus, Inc; 1997:407-25.

  15. Dominguez S. Maxillofacial trauma. In: Markovchick VJ, Pons PT, eds. Emergency Medicine Secrets. 2nd ed. Philadelphia, Pa: Hanley & Belfus, Inc; 1999:404-7.

  16. Ellis E 3rd, Scott K. Assessment of patients with facial fractures. Emerg Med Clin North Am. Aug 2000;18(3):411-48, vi. [Medline].

  17. Hendler BH. Maxillofacial Trauma. In: Rosen P, Barken R, eds. Emergency Medicine Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998:1098-103.

  18. Kaufman BR, Heckler FR. Sports-related facial injuries. Clin Sports Med. Jul 1997;16(3):543-62. [Medline].

  19. Thomas SH. Maxillofacial injuries. In: Harwood-Nuss AL, ed. The Clinical Practice of Emergency Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996:408-18.

  20. Tu HK, Davis LF, Nique TA. Maxillofacial injuries. In: The Team Physician's Handbook. 2nd ed. Philadelphia, Pa: Hanley & Belfus, Inc; 1997:426-37.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

maxillofacial fractures, tripod fractures, tetrapod fractures, blow-in fractures, blow-out fractures, blow out fractures, broken jaw, broken cheek, broken nose, Le Fort fracture, LeFort fracture, face fracture, nasal fracture, nasal bone fracture, orbital fracture, orbital floor fracture, orbital wall fracture

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Timothy J Rupp, MD, FACEP, Associate Medical Director, Physicians Emergency Care Associates, Methodist Health System, Dallas, Texas; Staff Physician, Innovative Emergency Medicine, Frisco, Texas; Staff Physician, Department of Emergency Medicine, Children's Medical Center of Dallas, Dallas, Texas
Timothy J Rupp, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Gay and Lesbian Medical Association, Society for Academic Emergency Medicine, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Steven Karageanes, DO, Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System
Steven Karageanes, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Chief, Sports Medicine, Associate Professor, Department of Orthopaedic Surgery, Medical College of Ohio
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.