Let’s Face It: EENT Injuries

Photo: Detroit Derby Girl Black Eyed Skeez has always protected her entire head when playing derby.

Eyes

Black Eye

Everyone knows what a black eye is. And though most of the time, a black eye is just a bruise around the eye, there are some warning signs of a more serious injury. If there are problems with vision (double vision or blurred), if there is loss of part or all of the vision ﬁeld, if there is a problem with movement of the eye, or if there is pain in the eye (especially with light sensitivity), there may be a more serious injury such as a fracture of the orbit, bleeding into the eye, or a detached retina. All eye injuries should be examined by your medical team.

Corneal Injury

With all the objects ﬂying around in derby (debris, hands, and elbows) and since many skaters wear contacts, it is no surprise eyes get injured. This is a painful injury - it will be hard to open the eyelid, light will make the pain worse, and there is profuse tearing. There may be some blurring of vision. The eye must be examined right away.

If any foreign matter is embedded in the cornea, the eye should be covered with a loose dressing, and the skater taken to the ER. If foreign matter is not embedded, washing it out with sterile saline or water is safe. Pain relief is needed - if the medical team does not have anesthetic eye drops, head to the ER. Most corneal abrasions will heal in two or three days; a doctor should follow the eye until it is healed, though.

Conjunctivitis

This simply means a blood-shot appearance of the white of the eye, but we commonly use the term to refer to an infection of the eye. There are other causes such as allergy or chemical irritation. We are most concerned about the infectious type because this is contagious by hands or objects. Here a painful, scratchy sensation is associated with a blood-shot white and thick mucus or pus drainage from the eye. Treatment is with antibiotic drops for 5 - 10 days; usually the person is no longer
contagious after completing 24 hours of treatment.

Allergy usually manifests with a itchy, scratchy feeling and a thin mucus discharge. It is not contagious. Antihistamines and steroids are usually the treatment.

Serious injuries are fortunately not common. But hard blows directly to the eyeball can cause bleeding into the eye or detached retina. There is pain, but more importantly, there is loss of part of the visual ﬁeld. These are serious - immediately take the skater to the ER!

Nose

Who hasn’t had a bloody nose? If you have a nasal injury, your medical team should stop the bleeding while being sure to contain the blood as well. To stop the bleeding, pinching the front third of the nose for 5 - 10 minutes is the best. Sometimes a nasal plug is needed; be sure to coat the plug with ointment ﬁrst. Once the bleeding is stopped, the nose should be examined for fracture or dislocation of the septum. These injuries can be seen within a day or two by a doctor.

One problem that can occur several days after the injury is a hematoma (a collection of blood) in the septum which can become infected. This is serious. The symptoms are pain, increasing tenderness, and difﬁculty breathing through the nose. See a doctor right away!

With the frequent use of nasal piercings, injuries involving tearing or complete removal of the piercing do occur. After stopping the bleeding, repair of the injury might be needed in the ER.

Ear

Again, piercings may present a chance for tearing out injuries. Stopping the bleeding is usually hard since the ear is has many blood vessels - a pressure dressing should work, though. Surgical repair might be needed.

If the ear is bruised and a collection of blood (hematoma) forms, this can injure the cartilage of the ear and cause a cauliﬂower ear. The blood must be removed within a day or two, before clotting occurs inside the ear.

A direct blow to the ear canal can cause an injury to the eardrum. The symptoms will be bleeding from the ear and loss of hearing. A doctor should see the skater right away.

Mouth and Jaw

The lips are injured from hits to the face causing cuts and/or bruising. Usually the teeth are protected by the mouth guard but should be checked for damage. Bruises can be managed with an ice pack. Bleeding should be stopped with ice and pressure. If the cut is not across the border of the red part of the lip, suturing is usually not needed and the cut will heal in several days. If the cut crosses the red border into the skin, it may need repair to prevent distortion of the lip. If there is a laceration of the gums or the bleeding is not stopping, sutures may be needed.

The tongue is rarely injured but occasionally cuts do occur. If the bleeding is easily stopped with ice and pressure, sutures usually won’t be needed. Your medical team should determine this.

With mouth guards, injuries of the teeth and gums are rare. However, I have seen teeth knocked loose. If a tooth is actually knocked out, it should be placed in saline, milk, saliva, or tucked inside the cheek to preserve it, and a dentist consulted as soon as possible.

We do see jaw injuries from time to time. Not surprising with a contact sport, but most of the ones we have seen have not been serious. Blows to the point of the jaw often cause injury to the TMJ (the joint where the jaw meets the skull). Actual dislocation can occur but requires more violent forces such as an auto accident. Dislocation would result in an off set of the jaw, making it hard to open or close the mouth.

The injuries I have seen have been more bruising of the TMJ, recovering with a soft diet and icing for
a few days. The other injury that comes with a blow to the side of the face is bruising of the muscle at back and side of the jaw. This results in muscle spasm pain with movement of the jaw but opening and closing is possible. Some people feel the jaw is slightly off position for a day or two. The treatment is a soft diet and icing for several days. If there is localized tenderness over the bone of the jaw, an X-ray might be a good idea.

At some point, consideration to use facial protection (i.e.,ﬂat plexiglass shields) might be a good idea.

Skate hard - put your heart into it - not your face.