Facial Injury - Football

Abstract

HISTORY: A 19 y/o NCAA division I football line backer sustained a facial injury during practice pursuing a tackle. He was wearing full pads & a "Boil N' Bite" mouth guard. He received a block that struck him on the right side of his mandible under the face mask. He had immediate pain & malocclusion of his teeth. There was no LOC. He had no change in vision, no difficulty swallowing & no paresthesias. He denied headache, dizziness, nausea, dyspnea & photophobia. There was no confusion or amnesia. He was promptly evaluated by the medical staff. PHYSICAL EXAMINATION: The airway was patent & there were normal breath sounds. There was gross displacement of the right mandible with step off between teeth 25 and 26 with a 5mm sagittal, intraoral laceration. There was malocclusion of the maxillary and mandibular dentition. He was able to open his mandible 15mm, but this caused severe pain. No tenderness over the mandibular condyles or the temporo-mandibular joints. Cranial nerves were intact. Normal sensation over the bilateral face and jaw. No tenderness of the maxilla or zygoma. No abnormal movement of the maxilla. No signs of concussion. DIFFERENTIAL DIAGNOSIS: 1) Mandibular Fracture 2) Maxilla Fracture 3) Temporo-mandibular joint fracture/dislocation 4) Tooth luxation TEST AND RESULTS: Panoramic radiograph of the maxilla and mandible -Right parasymphyseal mandible fracture Pulp Testing Tooth 26 -Non-vital tooth FINAL WORKING DIAGNOSIS: Right parasymphyseal mandibular fracture Nerve root injury to tooth 26 TREATMENT AND OUTCOMES: 1) Patient treated at outpatient oral surgery office within 1 hour of injury & started on oral PCN 2) Closed reduction with maxillo-mandibular fixation with arch bars & band fixation six hours post injury 3) No activity 1 week post injury 4) No contact sports × 4 weeks 5) Gradual increase in weight training 6) Nutrition evaluation for dietary intake 7) Goal 5-10% weight loss 8) 5% total weight loss (~12lbs) over 4 weeks 9) Removal of band fixation with free motion of TMJ at 3 weeks 10) Heavy aerobic conditioning at 3 weeks 11) Removal of arch bar fixation at 4 weeks 12) Custom multi-laminate mouth guard 3.5mm width that engaged & stabilized the mandible 13) Custom face mask 14) Tooth 26 nerve root injury caused by fracture & will need root canal therapy 15) Full contact at 4 weeks with full motion of mandible without pain