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5 Management of head/face trauma in football: a case report
  1. RN Rekik
  1. National Sport Medicine Program Department, Aspetar (Orthopaedic and Sport Medicine Hospital), Qatar

Abstract

About 11–40% of all sports injuries involve the face. In football, head/face injuries represent only 8 to 18% of all injuries. In Qatar national football championship, it was estimated during the last 3 seasons to 2%. Because of the growing interest in concussion, the majority of sport physicians know how to deal with such conditions, but other serious injuries such as face fractures can be underestimated. Sport physicians should be familiar with the anatomy of the facial region, the most common types of facial injuries and their initial management. A 33 year old football player, with unremarkable medical history, had a face trauma during a match in April 27 2014 (min 56). The first evaluation on field found a player suffering from headache, dizziness with balance disorder and pain on the right side of the face. There was no bleeding, no vomiting and no neck pain with normal vision and normal breathing. The Glasgow coma scale was 14/15. SCAT3 was performed and the decision was to substitute him and to transfer him to Hospital. The examination on the bench found normal vital signs and painful palpation of the upper right side of the face. There was no neurological deficit, no blurred vision and no cervical spine tenderness. The inspection and palpation of the nasal septum was normal. In hospital, skull X-rays (fontal and lateral view) were performed and gave normal findings. Then, he received an injection of Diclofenac (75 mg) which resulted in an improvement of his symptomatology. However, the reassessment noted a flattening of right cheek with numbness and a mild restriction in mouth opening. A CT scan showed a fracture of the anterior and lateral walls of the right maxillary sinus with hemosinus. He had surgery on April 28 2014 with good evolution and return to full training on July 15 2014. This case illustrates the importance of clinical examination. Moreover, if there is a history of sufficient force to result in suspected fracture then CT scan is usually the first investigation requested. If only X-rays are available, standard views for face imaging are Occipito-Mental (OM) and Occipito-Mental at 30 degrees angulation (OM30). In this context, the team physician should be familiar with immediate management of face/head trauma and if he is not comfortable with the acute management of the injury, should insist on more urgent care (or a second opinion) on behalf of his patient. Recognition of such conditions is critical for appropriate management and to preserve the health and career of the football player.

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