The Head and Neck

BONES OF THE SKULL

  1. The Cranial Bones
  2. Frontal
  3. Parietals (2)
  4. Temporal (2)
  5. Sphenoid
  6. Occipital
  7. Ethmoid

2. Facial Bones

a. Maxilla (2)

b. Mandible (1)

c. Nasal (2)

d. Zygomatic (2)

e. Vomer (1)

f. Lacrimal (2)

g. Palantine (2)

h. Inferior Nasal Conchae (2)

THE VERTEBRAL COLUMN

- 24 INDIVIDUAL VERTEBRAE

- Seperated by Intervertebral Discs

- Sacrum and Coccyx

  1. The Cervical Vertebrae

-C1 – C7

-Cervical Lordosis – normal curvature

2. Thoracic Vertebrae

- T1 – T12

- Articulate with the ribs

- ThoracicKyphosis

3. Lumbar Vertebrae

- L1 – L5

- Lumbar Lordosis

4. Sacrum

- 3 – 5 fused vertebrae

5. Coccyx

- 2 – 3 fused vertebrae

- “the tailbone”

6. Intervertebral Discs

- Annulus Fibrosus

Outer cartilaginous ring

- Nucleus Pulposus

Inner fluid

Abnormal Spinal Curvatures:

Scoliosis – an excessive lateral curvature of the spine

Kyphosis – an increased curvature in the thoracic spine – “hunchback”

Lordosis – an increase in the lumbar curvature -- “beer belly” or pregnant

women

INJURIES TO THE HEAD AND FACE

Facial Bone Fractures:

  1. Maxilla and Mandible fractures

Check for normal teeth alignment

May require wiring of teeth or bone

  1. Le Fort Fractures (French surgeon ReneLeFort 1869-1951)

Facial fractures involving the maxillary bone and surrounding structures

Classic in facial trauma

Le Fort I Fracture = Horizontal Fracture

Le Fort II Fracture = Pyramidal Fracture

Le Fort III Fractures = CraniofacialSeparation

  1. Orbital Fracture

4. Nasal fractures

Epistaxis – bloody nose

Leftuntreated – candevelop a ‘saddlenose’ deformity

5. Cauliflowerear

abuild up of fluidbetween the skin and the cartilage of the ear

needs to bedrained

6. Tympanic Membrane Rupture

theeardrum

caused by a hit or slap to the side of the head or changes in

pressure

Symptoms – painful pop, minorbleeding, unilateralhearingloss,

possible vertigo

7. SwimmersEar

Infection of the externalauditory canal

8. Knocked out tooth

pick up the tooth by the enamelonly

Re-implant within 30 minutes = 90% success

After 6 hours = <5%

The periodontal ligament needs to be intact

CONCUSSIONS

From the Latin word Concussus – to shake or be shaken violently

Common signs and Symptoms:

Dizziness

Headaches

Loss of coordination

Tinnitus – ringing in the ears

Amnesia – a condition in which one’s memory is lost

Retrograde amnesia – forgetting events that occurred before the trauma

Anterograde amnesia – forgetting events that occurred after the trauma

Second Impact Syndrome - fatal brain swelling that occurs following head trauma in individuals who still have symptoms from a prior head injury

THE STANDARD CONCUSSION ASSESSMENT TOOL – SCAT

  • The SCAT consists of two parts: a baseline evaluation typically taken before the season begins as well as one conducted after an athlete may have suffered a concussion
  • There is no definitive cut-off score that dictates whether a player can or cannot return to the game. Instead, the score is compared to the baseline test

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.

VISION

Sclera – “white of the eye”, gives shape to eyeball and protects inner structures

Cornea – transparent, anterior portion of the eye. Window through which light rays pass to the retina

Aqueous humor – watery fluid that fills the anterior chamber of the eye in front of the lens. Lack of drainage of this fluid = increased pressure = glaucoma

Iris – colored portion of the eye

Pupil – opening in the center of the iris through which light enters the eyeball

Lens – refracting mechanism of the eye that is located directly behind the pupil

Retina – innermost layer of the eyeball. Contains Rods and Cones

Rods – respond to dim light and black and white vision

Cones - provide daylight color vision

Optic nerve – sensory nerve that conducts visual information to the brain

Optic Disk – area in the retina where optic nerve fibers exit the eye

Contains no rods and cones - “Blind Spot”

Vitreous humor – gelatinous liquid that helps maintain the shape and transparency of the eye

THE SNELLEN EYE CHART– measures visual acuity

One of the sets of letters near the bottom of the chart is marked 20/20. The normal eye can clearly see these letters from the standard distance of 20 feet and is said to have 20/20 vision.

The letter at the top of the chart is marked 20/200. The normal eye can see this letter from a distance of 200 feet. Therefore, an eye that can only see the top letter from a distance of 20 feet is said to have 20/200 vision.

ACCOMMODATION TEST- accommodation is the changing of the shape of the lens that occurs when the normal eye is focused for close vision

COLOR BLINDNESS – Lack certain cones, usually the ones sensitive to reds and greens. More common in males (7%) than females (0.4%) since it is carried on the X cjromosome.

ASTIGMATISM – a condition that results from a defect in the curvature of the cornea or lens. Results in some portions of the image to be in focus and other portions to be out of focus.

CATARACT- a clouding of the lens of the eye

HYPHEMA – A collection of blood in the anterior chamber of the eye

STY – An infection of the small glands or hair follicles around the eye

CONJUNCTIVITIS – “PINK EYE” an infection of the membrane lining the inside of the eye – the conjunctiva

LASIK EYE SURGERY

Laser-Assisted in situ Keratomileusis

Who is eligible: need to have stable vision, which means people under the age of 18 rarely are eligible because their vision is usually not stable enough

Neck Injuries

The incidence of cervical spine (C-Spine) injuries in football players has been significantly lower than prior to the 1970”s

High Risk Sports:

Football, rugby, ice hockey, diving, gymnastics

Catastrophic injury – an injury that leaves a person permanently disabled for the rest of their life

Travis Roy: Boston University hockey player, paralyzed from neck down just 11 seconds into his 1st college shift as a freshman

-fractured his C4 and was a quadriplegic

-

Quadriplegic – paralysis of both arms and legs

Paraplegic – paralysis from the waist down, only involves the legs

Mechanism of Injury

Axial Load – the head is lowered (slightly flexed0 and a force is applied to the top of the head. This results in a straightening of the normal vertebral curve.

“do not lead with the head” in football This is spearing

Chucky Mullins