Maxillofacial fractures in football
Around 89.8% of the patients suffered maxillofacial fractures while 10.2% presented only soft tissue injuries; 13.9% had multiple fractures; 50% of the maxillofacial fractures concerned the zygomatic complex and 38.2% the mandible where the majority occurred at the angle
The prevailing mechanism was the direct impact of players.
1. Head to head impact outnumbered.
2. Elbow to head impact caused contusions of the temporo mandibular joint.
3. Kick to head impact was the main cause of multiple fractures
To fracture the mandible, signiﬁcant force is required therefore care must be taken to evaluate the athlete for possible concussion and/or brain injury. To determine if the athlete has a concussion or possible brain injury, the following symptoms may be detected:
5. Ringing in the ear
6. Inability to answer simple questions
1. If any of these symptoms are present, it may be safe to assume that the athlete may also have a concussion.
2. maintaining an open airway. With the athlete in a seated position, instruct the athlete to support his or her lower jaw. This position will allow the blood to ﬂow forward and out of the mouth rather than to the back of the throat.
3. When immobilising the jaw, care must be taken to ensure that the jaw is not displaced posteriorly; this could compromise the airway.
4. Bandages can be wrapped under the chin and over the top of the head.
5. An ice pack can be applied to the area to reduce the amount of swelling.
6. Jaw fractures necessitate emergency hospital care.
1. If the athlete has sustained a non-displaced jaw bone fracture, the healing can be managed conservatively with analgesia and rest to allow the fracture to heal properly. The athlete should only eat soft food for up to 4 weeks or as long as is recommended by the treating physician.
2. In displaced fracture of the jaw, surgery will usually require ﬁxation of the jaw with screws and plates. These will be in place for roughly 10 to 12 months. During this time, several follow-up visits will be necessary.
3. Most displaced jaw bone fractures will require closed reduction and internal ﬁxation for 4 to 6 weeks. While the athlete’s jaw is wired shut, the athlete should be consuming a high protein, high carbohydrate liquid diet which should be co-ordinated with a nutritionist.
HOW TO REDUCE THE RISK OF MAXILLOFACIAL INJURIES
The risk of jaw fractures in sports can be reduced by wearing a mouthguard especially in contact sports. The use of a mouthguard can also protect the teeth, lips, cheeks and tongue. They can even prevent more serious injuries of the head and neck.
There are three types of mouthguards:
Boil and bite.
Custom-made mouthguards provide the highest degree of protection, comfort and durability with optimal ﬁt. These are designed to cover all back teeth and cushion the entire jaw.
RETURNING TO SOCCER
In the initial phase, the athlete is only able to breathe through the nose and not the mouth.
Light activities such as stationary cycling, walking and light resistance exercises can be performed during the time of ﬁxation.
It is recommended that the athlete should not return to contact sport without protection.
Apart from initial acute trauma risks in jaw fractures
• Temporary or permanent loss of sensation in the face
• Loss of smell and/or taste
• Sinus infection
• Infection in the bones (osteomyelitis)
• Damage to the teeth
• Cosmetic concerns
• Infections can be a cause of delayed union, non-union, osteomyelitis and loss of teeth and bone structure.