Facial Injury- Football

Abstract

HISTORY: A 22-year-old University of Toledo defensive end was struck in the face by an opposing player. During a conference game this defensive lineman was rushin g the quarterback when he came into contact with the offensive tackle. The offensive tackle's left hand came through the defensive player's face mask and his thumb struck directly below the defensive player's eye. The player fell to the ground and subsequently ran off the field with his hand over his facemask. He reported severe eye and facial pain, as well as nausea and dizziness. PHYSICAL EXAMINATION: Sideline exam revealed a player in significant distress, unable to open his left eye. Procaine drops were administered without success. When the athlete's eye was opened it revealed that he was looking inferiorly, unable to look laterally or superiorly. Athlete was severely nauseated and displayed vertigo and diplopia upon exam. Athlete displayed immediate swelling and tenderness around orbital bones on the left side of his face. DIFFERENTIAL DIAGNOSIS: 1. Orbital Fracture 2. Ruptured Globe 3. Traumatic Optic Neuropathy 4. Retrobulbar Hemorrhage TEST AND RESULTS: CT brain without contrast: -No acute intracranial hemorrhage, infarct, or mass effect. Ventricles normal in size and position. Gray and white matter interface normal. -Left periorbital soft tissue swelling with intra orbital gas. Fracture of left orbital wall. CT facial without contrast: -Depressed fractures of the left orbital floor as well as the medial wall of the left orbit. -Orbital fat extends through the floor defect with partial entrapment of the inferior rectus muscle. Medial rectus muscle is displaced medially and is swollen. -Fluid/hemorrhage in the left maxillary sinus and also the left ethmoid air cells. FINAL WORKING DIAGNOSIS: 1. Left orbital floor fracture 2. Left medial orbit fracture with orbital contusions 3. Entrapment of the left inferior rectus muscle TREATMENT AND OUTCOMES: 1. ORIF of the left orbital floor fracture 2. ORIF of the left medial orbit and nasal wall fracture 3. Return to light exercise and activity at 3 weeks 4. Return to practice and contact exercise at 4 weeks 5. Game play at four and a half weeks with enclosed face mask and eye shield