Medicine & Science in Sports & Exercise:
A-19 Clinical Case Slide - Chronic Conditions I: MAY 30, 2007 9:30 AM - 10:50 AM ROOM: 341
Barnes, Kenneth P.1; Rouzier, Pierre A. FACSM2
1Bay state Medical Center, Springfield, MA.
2University of Massachusetts Amherst, Amherst, MA.
HISTROTY: A 21 year-old Junior Lacrosse Player sustained an injury to his chin. During the 4th quarter an opposing player delivered a traumatic forceful cross-check that was directed in an upward manner to the anterior-inferior aspect of his jaw. Medical staff on site found the athlete to be in considerable pain with a noticeable laceration on his chin and blood extravasating from the right ear.
PHYSICAL EXAMINATION: On field examination found the athlete to be alert and oriented x3, no LOC. A gross neurological exam was within normal limits without motor, sensory or cerebellar deficits. Communication was appropriate. He complained of decreased hearing on the right which progressed to a sensation of full unilateral hearing loss as blood collected in the right external auditory canal. PERRL. EOMI. Unable to assess right ear secondary to bleeding. Normal left external auditory canal and tympanic membrane. Teeth were in alignment. A 2 cm vertical laceration was present on the anterior aspect of the chin with moderate pain at the right temporomandibular joint (TMJ).
1. Basilar Skull Fracture
2. TMJ Fracture
3. Ruptured Tympanic Membrane
4. Facial Laceration
TEST AND RESULTS: CT Head/Brain without Contrast:
- Non-displaced fracture through the posterior wall of the right temporomandibular joint extending into the external auditory canal without extension into the mastoid air cells
- Air seen dissecting into the soft tissues of the neck from the fracture inferiorly.
- No mandibular fracture or displacement seen
- Brain unremarkable in appearance with normal ventricular system.
- No midline shift
- Bone windows were unremarkable
FINAL WORKING DIAGNOSIS: Non-displaced fracture through the posterior wall of the right TMJ extending into the external auditory canal with associated lacerations to the face and the right ear canal.
TREATMENT AND OUTCOMES:
A) TMJ Fracture:
1. ENT and Oral Surgeon evaluation
2. Week 2: Light sport specific aerobic activity
3. Week 2: Fitted with a modified helmet, mandibular protective device and custom-made mouth piece
4. Week 3: Advanced to non-contact drills
5. Week 4: Pain and symptom free; able to meet the demands of his sport; cleared to play
B) Facial laceration:
1. Cleaned, irrigated and prepped in the usual sterile fashion
2. 7 interrupted sutures placed and removed 5 days later