Kategoriarkiv: Head



Management of simple midfacial fractures, particularly in professional soccer players.

Eufinger H, Heise M, Rarreck T. Sportverletz Sportschaden 2000 Mar;14(1):35-40.

Uncomplicated midfacial fractures represent a frequent and typical injury of soccer-players in oral and maxillofacial surgery. The treatment of these fractures in professional players requires special treatment modalities, especially concerning quick rehabilitation. The examples of a nasal bone fracture, a malar bone fracture and a zygomatic arch fracture in 3 professional soccer players demonstrate the therapeutic principles of these most common uncomplicated midfacial fractures. In this context the fabrication of individual facial masks is presented, which allow an improved postoperative protection and therefore an earlier participation of the player in training and matches.



Concussion in sports. Guidelines for the prevention of catastrophic outcome.

Kelly JP, Nichols JS, Filley CM, Lillehei KO, Rubinstein D, Kleinschmidt-DeMasters BK. JAMA 1991 Nov 27;266(20):2867-9.

Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.



Cerebral concussion in sport. Management and prevention.

Cantu RC. Sports Med 1992 Jul;14(1):64-74.

This article explains the various stresses (tensile, compressive, and shearing) that can affect the brain, and how they may produce the different types of brain injury. The biomechanical forces and dynamics that produce coup versus contra coup injury are covered, as are the common intracranial athletic head injuries, i.e. concussion and the various intracranial haematomas (epidural, subdural, subarachnoid and intracerebral). Though less common in occurrence, because their outcome is so catastrophic, space is also devoted to the recognition, the treatment and (especially in the latter case) the prevention of the malignant brain oedema syndrome of the adolescent and the second impact syndrome of the adult. A major emphasis of this paper is the recognition of the 3 grades of cerebral concussion and the delineation of clear guidelines as to when it is safe to return to collision sports after sustaining such injuries, for the first, second or third time during a given season. Clear guidelines are also presented as to when to discontinue collision sport competition for the remainder of the season after multiple concussions. Because of the concern for the second impact syndrome, the requirement to never allow an athlete with postconcussion syndrome symptoms to return to competition is emphasised. Also covered is the prevention of head injuries, which sports are at greatest risk, and the need for additional research on the cumulative effects of concussion.



Assessment and management of concussion in sports.

Harmon KG. Am Fam Physician 1999 Sep 1;60(3):887-92, 894.

The most common head injury in sports is concussion. Athletes who sustain a prolonged loss of consciousness should be transported immediately to a hospital for further evaluation. Assessment of less severe injuries should include a thorough neurologic examination. The duration of symptoms and the presence or absence of post-traumatic amnesia and loss of consciousness should be noted. To avoid premature return to play, a good understanding of the possible hazards is important. Potential hazards of premature return to play include the possibility of death from second-impact syndrome, permanent neurologic impairment from cumulative trauma, and the postconcussion syndrome.



Neuropsychological impairment in amateur soccer players.

Matser EJ, Kessels AG, Lezak MD, Jordan BD, Troost J. JAMA 1999 Sep 8;282(10):971-3.

Soccer players incur concussions during matches and training sessions, as well as numerous subconcussive blows to the head from impacts with the soccer ball (headers). The combination of soccer-related concussions and the number of headers may be a risk for chronic traumatic brain injury (CTBI).

To determine whether amateur soccer players have evidence of CTBI. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 33 amateur soccer players and 27 amateur athletes involved in swimming and track (controls) in the Netherlands who underwent interviews and neuropsychological testing.

Performance of soccer players vs controls on 16 neuropsychological tests having 27 outcomes.

Compared with control athletes, amateur soccer players exhibited impaired performance on tests of planning (39% vs 13%; P=.001) and memory (27% vs 7%; P=.004). Among soccer players, 9 (27%) had incurred 1 soccer-related concussion and 7 (23%) had had 2 to 5 concussions during their career. The number of concussions incurred in soccer was inversely related to the neuropsychological performance on 6 of the neuropsychological tests.

Our results indicate that participation in amateur soccer in general and concussion specifically is associated with impaired performance in memory and planning functions. Due to the worldwide popularity of soccer, these observations may have important public health implications.



Fatalities from head and cervical spine injuries occurring in tackle football: 50 years’ experience.

Mueller FO. Clin Sports Med 1998 Jan;17(1):169-82.

Football head and cervical spine fatalities have been related to 84.9% of all football fatalities from 1945 through 1994. The decade from 1965 through 1974 was responsible for the greatest number and percentage of head and cervical spine fatalities, and the two decades from 1975 through 1994 were associated with the smallest number and percentage. The data reveal that most head and cervical spine fatalities are related to high school football players either tackling or being tackled in a game. Most head fatalities are subdural hematomas, and almost all of the cervical spine fatalities are fractures, dislocations, or fracture-dislocations. There has been a dramatic reduction in these types of fatalities during the last two decades, 1975 through 1994, and the preventive measures that have received most of the credit have been the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling, the NOCSAE helmet standard that went into effect in colleges in 1978 and high schools in 1980, better coaching in the techniques of blocking and tackling, and improved medical care. There has been a reduction of head and cervical spine fatalities, but the analysis of data for the next decade, 1995 through 2004, will reveal the continued effects of the preventive measures discussed and continued research efforts. A number of researchers have stated that in order for the head and cervical spine fatalities to continue decreasing, there must be increased helmet research with an emphasis on concussions and neck injuries. Will the number of fatalities continue to decrease? Only time will tell.



Epistaxis: a review of hospitalized patients.

Huang CL, Shu CH. Zhonghua Yi Xue Za Zhi (Taipei) 2002 Feb;65(2):74-8

BACKGROUND: Epistaxis is a common disease. That is usually self-limited and controlled by extemal compression. However, posterior epistaxis is occasionally complicated and needs hospitalization. The aim of this study is to analyze the etiology of epistaxis that requires hospitalization, and present the results of the treatments. METHODS: From June 1997 to May 1999, 44 patients admitted under diagnosis of epistaxis were retrospectively investigated. Among these patients, 7 were admitted twice for epistaxis. The demographics, administrative history, post-history and associated diseases, treatment and complications were analyzed. Noninterventional treatment comprised of nasal packing and local electrocauterization; interventional treatment included surgery and embolization. RESULTS: The mean age of the patients enrolled was 53.4 years. Men outnumbered women in a rate of 3:1. The mean length for hospital stays was 8.1 days for noninterventionally-treated patients, 11.8 days for interventionally-treated patients. Emergency room visit prior to admission was noted in 68.6% of the patients. Hypertension, nasopharyngeal carcinoma (NPC) after radiotherapy, a history of nasal operations and smoking were four major associated diseases. The failure rate to control the epistaxis was 26.7% for noninterventional treatments and 16.7% for interventional treatments. The complication rate was 2% for the entire study, and the mortality rate was 7.8%. All the mortal patients were post-irradiation NPC patients with internal carotid artery bleeding. CONCLUSIONS: Most epistaxis patients can be managed in a noninterventional manner. Interventional treatment is only warranted in those whose epistaxis persists after adequate noninterventional treatment. For internal carotid artery epistaxis in NPC patients, embolization should be performed as soon as possible.



Mouth guard protection for prevention of athletic injuries to teeth, mouth and jaw.

Mischkowski RA, Siessegger M, Zoller JE. Sportverletz Sportschaden 1999 Sep;13(3):65-7.

Sport is well known as a common cause of dental and oral injuries. Sports-related injuries account for 13% to 39% of all trauma cases in this area. The knowledge about prevention of dental and oral injuries among hobby and professional athletes can be regarded as not satisfactory yet. Mouth guards are considered as one of the most effective means for injury prevention. However, no statements or recommendations regarding use of mouth guards in sports have been published in German language literature yet. The following review article describes several types of available mouth guards and discuss their advantages and disadvantages. Guidelines concerning indications and use of mouth guards are presented.



Athletic mouth guards prevent orofacial injuries: a review.

Woodmansey KF. Gen Dent 1999 Jan-Feb;47(1):64-9; quiz 70-1.

Athletes who participate in competitive and recreational sports are at significant risk of orofacial injury. The use of mouth guards can reduce that risk substantially. The known incidence of orofacial trauma and benefits of athletic mouth guard use are reviewed. Dental health professionals are advised to advocate mouth guards for athlete-patients.



Ocular sports injuries: the current picture.

Barr A, Baines PS, Desai P, MacEwen CJ. Br J Sports Med 2000 Dec;34(6):456-8.

To determine the recent incidence of eye injury due to sport in Scotland, identify any trend, and establish which sports are responsible for most injury? The type of injury and final visual outcome is also evaluated.

A prospective observational study of ocular injuries sustained during sport was performed over a one year period. Only patients requiring hospital admission were included. Data were collected on a standardised proforma and entered into a central database. Patients were followed up for at least three months.

Of 416 patients admitted because of ocular injury, 52 (12.5%) resulted from playing a sport. Although all racquet sports together accounted for 47.5% of these injuries, football was the single most common sport associated with ocular trauma, being responsible for 32.5% of cases. The most common clinical finding was macroscopic hyphaema occurring in 87.5% of patients. Overall the final visual acuity was 6/6 in 92.5% of patients.

The incidence of eye injury due to sport at 12.5% is lower than previously reported, suggesting a change in the pattern of ocular trauma. Football is the single most common cause of ocular injury from sport in Scotland, but the wearing of protective headgear would be difficult to instigate. The incidence of hyphaema in sport related ocular trauma (87.5%) is almost double that of all ocular injury (47.8%), so the potential for serious visual loss as the result of a sports injury should not be underrated. Ophthalmologists have a role in protecting this young population at risk by actively encouraging the design and use of protective eyewear.