Mihalik Jason P, Myers Joseph B, Sell Timothy C, Anish Eric J
* University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Athl Train. 2005 Jun;40(2):116-119.
Objective: To present the case of a 17-year-old male soccer goalkeeper who sustained maxillofacial fractures and dental trauma after being struck in the face by an opponent's knee.Background: Because of the nature of the sport and a lack of protective headgear, soccer players are at risk for sustaining maxillofacial trauma. Facial injuries can complicate the routine management of on-field medical emergencies often encountered by certified athletic trainers. The appropriate management of maxillofacial trauma on the playing field may help to reduce both the immediate and long-term morbidity and mortality associated with these injuries.Differential Diagnosis: Lacerated superior labial artery, lacerated upper lip, dental fractures, maxillofacial fractures, orbital blowout fracture, closed head injury, cervical spine injury, cerebrovascular accident.Treatment: The athlete received immediate on-field medical care and was subsequently transported to the hospital, where diagnostic testing was performed and further treatment was provided. Hospital inpatient management included dental and plastic surgery. After discharge from the hospital, the athlete underwent several additional dental procedures, including gingival surgery and nonsurgical endodontic treatments. The fractures were followed closely to assure that adequate healing had occurred. The athlete did not return to soccer.Uniqueness: Certified athletic trainers need to be prepared for on-field medical emergencies. Bleeding associated with maxillofacial trauma can complicate basic medical interventions such as airway maintenance. Inappropriate on-field management may result in unnecessary morbidity and mortality for the injured athlete. Therefore, immediate recognition of the severity of the injury is needed in order to institute appropriate airway-management strategies.Conclusions: It is sometimes necessary to consider nonstandard methods of airway management in order to first address heavy bleeding that may be associated with facial trauma. Achieving hemostasis is essential in order to prevent potentially life-threatening complications related to hemorrhage, such as airway obstruction and hypovolemic shock.
介绍一名17岁男性足球守门员的病例，该患者在被对手膝盖击中面部后遭受颌面骨折和牙齿外伤。背景：由于这项运动的性质以及缺乏防护头盔，足球运动员有遭受颌面创伤的风险。面部损伤会使认证运动训练师在现场经常遇到的医疗紧急情况的常规处理变得复杂。在运动场上对面部创伤进行适当处理可能有助于降低与这些损伤相关的近期和长期发病率及死亡率。鉴别诊断：上唇动脉撕裂、上唇撕裂、牙齿骨折、颌面骨折、眼眶爆裂骨折、闭合性头部损伤、颈椎损伤、脑血管意外。治疗：该运动员在现场立即接受了医疗护理，随后被送往医院，在那里进行了诊断检查并提供了进一步治疗。医院住院治疗包括牙科和整形手术。出院后，该运动员又接受了几次额外的牙科治疗，包括牙龈手术和非手术牙髓治疗。对骨折情况进行密切跟踪以确保已充分愈合。该运动员未重返足球运动。独特之处：认证运动训练师需要为现场医疗紧急情况做好准备。与颌面创伤相关的出血会使诸如气道维持等基本医疗干预变得复杂。不恰当的现场处理可能会给受伤运动员带来不必要的发病率和死亡率。因此，需要立即识别损伤的严重程度以便制定适当的气道管理策略。结论：有时有必要考虑采用非标准的气道管理方法，以便首先处理可能与面部创伤相关的大量出血。实现止血对于预防与出血相关的潜在危及生命的并发症（如气道阻塞和低血容量性休克）至关重要。
