Nasal Injuries in Sports

This article describes nasal injuries commonly seen in sports activities. Although these constitute the most common facial injuries, they are often associated with other injuries, particularly fractures to the malar Zygoma complex, the maxilla and the mandible. Treatment consists of stopping bleeding from the nose, and in covering nasal lacerations until more definitive care can be instituted.     

Down man on the field.

Rapid evaluation and treatment of playing-field injuries can save a patient's life and prevent further injury. These outcomes are possible if trained personnel, who are familiar with athletic injuries, are present. This article presents basic procedures for adequate preparation, step-by-step assessment, and management of emergencies on the field, including cardiovascular emergencies; anaphylaxis; central nervous system injuries; abdominal and pelvic injuries; eye, ear, and nose injuries; and extremity injuries.     

Common Causes of Disturbed Nasal Function

The frequency of nasal injuries is very high in the prenatal, natal and early childhood periods.

Seemingly minor injuries may later result in major nasal deformities. As children's nasal bones are small and nasal fractures infrequent, roentgenographic diagnosis is ureliable. Most injuries involve the cartilaginous structures, and usually the septum. Immediate diagnosis and early treatment are imperative to avoid irreparable damage. Operative rather than palliative treatment is necessary. Compresses and antibiotics have little value.

Prompt and skillful attention to minor injuries of the nose will do much toward reducing the incidence of nasal obstructions and deformities.     

Emergency ear, nose, and throat procedures

This comprehensive article reviews some of the most common injuries to the ear, nose, and throat, and in addition reviews the relative anatomy of this area of the body. Particular attention is paid to the treatment of the patient with epistaxis, a common presentation to the Emergency Department.     

Management of acute nasal fractures

In cases of facial trauma, nasal fractures account for approximately 40 percent of bone injuries. Treatment in the primary care setting begins with evaluating the injury, taking an accurate history of the situation in which the injury occurred, and ascertaining how the face and nose appeared and functioned before the injury occurred. Serious injuries should be treated, then nasal inspection and palpation may be performed to assess for airway patency, mucosal laceration, and septal deformity. A thorough examination of the nose and surrounding structures, including the orbits, mandible, and cervical spine, should be completed. Imaging studies are necessary for facial or mandibular fractures. Patients with septal hematomas, cerebrospinal fluid rhinorrhea, malocclusion, or extraocular movement defects should be referred to a subspecialist. Treatment in the primary care setting consists of evaluation, pain and infection management, minimal debridement and, when the physician is appropriately trained, closed reduction. If an immediate referral is not indicated, close follow-up, possibly with a subspecialist, should be arranged within three to five days after the injury.     

The value of radiographs in the management of the fractured nose.

Over a 6-month period a record was kept of all patients presenting to the accident and emergency (A&E) department with nasal injuries. The results of the nasal radiographs were analysed to gauge their benefit. It was found that there was poor correlation between the radiological findings and the presence of external deformity, the latter determining the decision to carry out treatment. Routine radiographs of the nose are unnecessary in patients with nasal trauma.     

Nasal trauma

The nose occupies the center of the face, and its appearance may be more important to us than its function. It is also the chief conduit of the air we breathe, however. It warms, moistens, and cleans that air. It tells us if dinner is going to be good or if the house is on fire. Nasal injuries therefore must be treated with respect. An examination requires good lighting, suction, and a nasal speculum. The two disasters to avoid are delayed referral of a displaced fracture or cartilage, and nontreatment of a septal hematoma.     

Determining the Prevalence and Assessing the Severity of Injuries in Mixed Martial Arts Athletes

Background

Mixed martial arts (MMA) is currently the fastest growing sport in the United States and has recently surpassed boxing as the most popular full contact sport. Due to the physical nature of the sport, MMA is associated with various types of injuries.

Objective

The purpose of this study was aimed at identifying prevalence and assessing the severity, location, and type of injuries in MMA athletes sustained during MMA related activities in the twelve month period prior to the survey.

Methods

A total of fifty-five subjects between the ages of 18 to 39 participated in the study. Participants were given a two-part questionnaire to collect demographic and injury data.

Results

Two hundred seven injuries were reported in the study. Low belt ranks had significantly more injuries more than any other belt rank, resulting in more than two times higher injury rate. Professional fighters had significantly more injuries than amateur fighters, resulting in three times higher injury rate. The most common body region injured was the head/neck/face (38.2%), followed by the lower extremities (30.4%), upper extremities (22.7%), torso (8.2%), and groin (0.5%). Injuries to the nose (6.3%), shoulder (6.3%), and toe (6.3%) were the most common. The most common type of injury was contusions (29.4%), followed by strains (16.2%), sprains (14.9%), and abrasions (10.1%).

Conclusion

Injury prevention efforts should consider the prevalence and distribution of injuries and focus on reducing or preventing injuries to the head/neck/face in MMA related activities. Preventative measures should focus on improving protective equipment during training, and possible competition rule modifications to further minimize participant injury.     

复杂肢（指）体组织及器官离断伤救治研究

目的 探讨有关特殊类型肢（指）体组织及器官离断损伤的显微再植和修复方法。方法回顾分析了合并复合组织缺损的肢体离断伤再植修复72例，多肢体离断再植19例40侧肢体，多指多节段离断再植26例63节段，双手十指离断再植4例，复合组织离断再植59例，70岁以上高龄肢体离断5例以及特殊器官离断伤11例。采用原位再植、交叉再植、组织移植等显微外科技术进行修复。结果对其中162例患者随访3个月～10年，功能恢复情况为上肢：优27例，良35例，差12例，优良率83．8％；下肢：优33例，良34例，差11例，优良率85．9％：外耳再植成活5例，皮瓣修复重建耳廓2例全部成活，阴茎及睾丸再植2例全部成活，舌体再植1例失活，鼻离断再植1例失活。结论对特殊组织器官离断损伤，采用原位再植、交叉再植、寄养冉植、皮瓣转移、组织移植等显微重建方法进行修复可使损伤组织器官恢复原有的外形和功能。     

Die traumatische atlantoaxiale Dislokation (AAD)

Rotatory atlantoaxial dislocation (AAD) is a relatively uncommon injury which normally occurs as Grisel’s syndrome in connection with infections of the upper airway and surgery in the ENT (ear, nose and throat) region. It is an important differential diagnosis of acute and especially chronic torticollis in children and a thorough analysis of the anamnesis and examination by palpation are therefore indispensible for every torticollis. The traumatic cause of torticollis is less well-known and it is not uncommon that other injuries are in the forefront so that the diagnosis of AAD is delayed. The anamnesis commonly reveals impact trauma and falls, often in connection with clavicle fractures. Clinical findings in the area of the atlanto-occipital joint are often very conspicuous and a prerequisite for the tentative diagnosis is a thorough palpation in a supine position. Often analogue x-ray images do not lead to a certain diagnosis. In cases of more severe postural deformities which cannot be corrected during positioning for x-ray examination or passive straightening of the head, special attention should be paid to the cranio-cervical junction. When in doubt computed tomography (CT) imaging should always be performed as this is superior to magnetic resonance imaging (MRI) for the diagnostics of AAD. However, MRI is superior to CT for the assessment of accompanying soft tissue injuries.     

Injury risk in professional boxing

OBJECTIVE: Although a popular endeavor, boxing has fallen under increased scrutiny because of its association with traumatic brain injury. However, few studies have investigated the overall epidemiology of boxing injuries from representative samples, and no study has ever documented the incidence of injuries in female boxers. This study is a review of professional boxing data from the state of Nevada from September 2001 through March 2003. MATERIALS AND METHODS: Medical and outcome data for all professional boxing matches occurring in Nevada between September 2001 and March 2003 (n = 524 matches) were analyzed on the basis of a pair-matched, case-control design. Cases were boxers who received an injury during the boxing matches. Boxers who were not injured served as control subjects. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. RESULTS: The overall incidence rate of injury was 17.1 per 100 boxer-matches, or 3.4 per 100 boxer-rounds. Facial laceration accounted for 51% of all injuries, followed by hand injury (17%), eye injury (14%), and nose injury (5%). Male boxers were significantly more likely than female boxers to receive injuries (3.6 versus 1.2 per 100 boxer-rounds, P = 0.01). Male boxing matches also ended in knockouts and technical knockouts more often than did female matches (P < 0.001). The risk of injury for those who lost the matches was nearly twice the risk for the winners. Those who lost by knockout had double the risk of injury compared with those who lost by other means. Neither age nor weight was significantly associated with the risk of injury. CONCLUSIONS: The injury rate in professional boxing matches is high, particularly among male boxers. Superficial facial lacerations are the most common injury reported. Male boxers have a higher rate of knockout and technical knockouts than female boxers. Further research is necessary to determine the outcomes of injury, particularly the long-term neurologic outcome differences between sexes.     

中国美貌汉族女性鼻部特征的测量

背景:目前,鼻外型的美学指标尚不统一建立中国美貌汉族女性鼻部特征的数据库,可以为美容整形治疗计划的制定提供理论依据。目的:对公众广泛接受的30例中国美貌汉族女性的鼻部特征进行了测量,观察中国美貌汉族女性鼻部的美学特征。方法:选取30例时尚杂志、电影、电视剧中美女明星的正、侧位脸型的照片,利用photoshop CS3.0软件对30例中国美貌汉族女性的16个外鼻指标进行测量分析。结果与结论:实验获得明星外鼻的长度、宽度、高度、深度和相关比例等多组美学、解剖学数据,包括:鼻宽-鼻长比为1∶1.15,鼻深-鼻宽比为1∶2,鼻宽-内眦间距比为1∶0.94,鼻宽-口角间距比为1∶1.43,且各比例相互间有一定相关性。结果证实,中国美貌女性鼻唇沟间距与鼻宽之比接近黄金比1∶0.618,外鼻相对面部不够突出。     

中国美貌汉族女性鼻部特征的测量

背景：目前,鼻外型的美学指标尚不统一建立中国美貌汉族女性鼻部特征的数据库,可以为美容整形治疗计划的制定提供理论依据.目的：对公众广泛接受的30例中国美貌汉族女性的鼻部特征进行了测量,观察中国美貌汉族女性鼻部的美学特征.方法：选取30例时尚杂志、电影、电视剧中美女明星的正、侧位脸型的照片,利用photoshop CS 3.0软件对30例中国美貌汉族女性的16个外鼻指标进行测量分析.结果与结论：实验获得明星外鼻的长度、宽度、高度、深度和相关比例等多组美学、解剖学数据,包括：鼻宽-鼻长比为1∶1.15,鼻深-鼻宽比为1∶2,鼻宽-内眦间距比为1∶0.94,鼻宽-口角间距比为1∶1.43,且各比例相互间有一定相关性.结果证实,中国美貌女性鼻唇沟间距与鼻宽之比接近黄金比1∶0.618,外鼻相对面部不够突出.     

多层螺旋CT在鼻骨骨折中的诊断价值

目的：探讨多层螺旋CT（Multi-slice spiral CT,MSCT）在鼻骨骨折的临床诊断价值。材料与方法：60例鼻外伤病人均行MSCT容积扫描后行多种后处理图象重建并与X线片进行分析比较。结果：X线片60例患者中诊断鼻骨骨折者28例,8例可疑骨折,其余未见明显骨折。60例患者行MSCT容积扫描后行多种后处理图象重建后显示鼻骨骨折56例,其中单侧鼻骨骨折33例,双侧鼻骨骨折23例,伴上颌骨额突骨折40例,伴泪骨骨折8例,伴鼻中隔骨折15例,骨折伴鼻额缝分离13例,鼻骨间缝分离移位18例,并发眶壁骨折12例,伴鼻颌缝分离移位38例,上颌窦壁骨折5例。4例MSCT检查未见异常。结论：MSCT容积扫描检查鼻骨骨折明显优于常规CT和X线平片。MSCT检查能准确地显示鼻骨及周围各骨结构,对鼻骨骨折的类型、部位及其伴发改变显示全面、准确,是当前诊断鼻骨骨折的一种可靠、安全、有效的检查方法,为临床选择治疗方案和法医学鉴定提供可靠依据。     

120例鼻喉部恶性肿瘤血清唾液酸检测分析

目的探讨血清唾液酸（SA）水平对鼻喉部肿瘤诊断的应用价值。方法采用高特异性UV法（日本Wako公司试剂盒）对100例健康对照者,120例鼻喉部良性疾病患者和90例鼻喉部恶性肿瘤患者检测血清SA浓度,比较两组间血清SA水平差异。结果鼻喉部恶性肿瘤组血清SA水平显著高于健康对照组及良性疾病组,差异有统计学意义（P〈0．001）,良性疾病组与健康对照组间SA水平差异无统计学意义（P〉0．05）。结论血清SA测定对鼻喉部恶性肿瘤的辅助诊断具有一定的参考价值。     

中国人脸形分布与生物防护口罩设计研究

为设计出适用于我国人脸形的生物防护口罩 ,选择有代表性人群 ,对人的面宽、面长、颧点距、鼻中宽和鼻中高等参数进行了精确测量。结果 ,我国人群面宽范围为 115～ 16 5mm ,面长为 6 2～ 12 2mm ,颧点距为 72～ 136mm ,鼻中宽为 2 0～ 4 5mm ,鼻中高 8～ 2 7mm ,其中变异最大的为鼻中高。结果提示 ,面长和颧点距是设计口罩外形尺寸的必要参数 ,鼻中宽和鼻中高是设计鼻部密封结构的重要参数 ,鼻部的密封是口罩设计的关键因素。根据调查结果 ,提出了半脸式口罩的设计参考尺寸。     

鼻内窥镜鼻窦手术93例护理体会

目的介绍鼻内镜鼻窦手术护理体会。重点讨论鼻内镜手术前后护理、并发症的观察及护理,预防和避免并发症的发生,以保证治疗效果,提高治愈率。方法对本组93例慢性鼻窦炎、鼻息肉行鼻内镜手术。结果治愈82例(88.2%),好转8例(8.6%),无效3例(3.2%),总有效率(96.7%),3例无效者均为未按时复查换药患者。并发症鼻粘连12例,窦口闭锁3例,术后出血2例。结论鼻内镜手术治疗慢性鼻窦炎、鼻息肉疗效显著,在护理的过程中笔者体会到术后的随访是提高手术治愈率的重要环节,术后定期内镜下清除术腔肉芽、血痂、囊泡组织及分泌物,及时解除鼻腔粘连,是彻底治愈鼻窦炎的重要阶段。缺乏上述处理,难以获得良好的手术效果。因此,要在患者出院宣教中重点强调术后随访的必要性和重要性。     

中山市313例企业工人意外伤害情况分析

目的了解中山市部分企业工人意外受伤的原因、种类及分布特征,为今后有针对性制定预防意外伤害措施提供科学依据。方法对中山市2003年313例企业工人工伤定级个案资料记录卡进行回顾分析。结果313例工伤人员中,男252人,女61人,男女比例为4.13︰1;受伤部位前三位依次是:上肢损伤、下肢损伤、五官损伤;受伤原因主要是操作不熟练、超时作业、缺乏个人防护等;发生行业主要有五金行业、家电行业、家具制造业及塑料制造业等。结论应针对企业工人受伤原因及受伤部位的发生率,制定有效的预防措施,加强安全意识及心理健康教育,提高工人的自我保护意识。     

Minor injuries in older adults have different characteristics,injury patterns,and outcomes when compared with younger adults: An Emergency Department correlation study

AimTo examine the injury patterns, characteristics, and outcomes of older adults presenting with minor injuries compared with younger adults.BackgroundSustaining a minor injury is one of the most common reasons people present to an Emergency Department. Many presentations involve older Australians and greater than 50% of older adults are discharged from the Emergency Department. However, little is known about the characteristics, injury patterns, and outcomes of minor injuries in older adults compared to younger adults.MethodsA 12-month exploratory correlational study was conducted using Emergency Department electronic medical record data from a single metropolitan hospital located in Sydney, Australia. Older adults were defined as ≥65 years with younger adults defined as 18–64 years. Minor injuries were classified by diagnoses as fractures/dislocations, sprains/strains, wounds/burns/infections, minor head injuries, eye/ear/nose/oral injuries. Exclusion criteria included: triage category 1 or 2, major trauma, critical care admission, or injuries and fractures to the hip or neck of femur.ResultsThere were 36,671 Emergency Department presentations of which 7582 (21%) were for older adults and 19,234 (52%) were younger adults (aged 18–64). Injuries represented 21% (n = 7754) of all Emergency Department presentations with 1294 (17%) occurring in those aged 65 years and older and 3937 (20%) in younger adults. Of the minor injuries (n = 3594; 10%), the most common presentation in younger adults was sprains/strains (n = 1045; 36%) but in older adults it was fractures (n = 229; 32%). There was a statistical (Pearson's χ² test 63.4, df = 4, P < 0.001) difference with injury pattern when comparing age groups. Older adults were allocated proportionately higher triage categories when compared with younger adults (Pearson's χ² test 26.3, df = 2, P < 0.001). Older adults with minor injuries had a longer mean stay (315 min; SD 238.9 min; younger adults 198 min, SD 132.3 min) and this difference was statistically (P ≤ 0.001) and clinically significant. Fewer older adults were discharged home (n = 531, 73%; n = 2648, 92%; P < 0.001) and more were admitted for minor injuries (n = 179, 25%; n = 156, 5%; P < 0.001) when compared with younger adults.ConclusionOlder adults with minor injuries have different injury patterns, higher acuity, longer length of stay, and lower discharge rates compared with younger adults. Clinicians may need to modify their approach and differential diagnoses when treating older adults with minor injuries. Further research is needed to explore the reasons for these differences and whether older adults have different service needs compared with younger adults with minor injuries.