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Introduction

Even when appropriate equipment is used, the face, nose, mouth, and ears are vulnerable to injury. However, rules requiring the use of face masks and mouthguards have reduced the number and severity of injuries to the maxillofacial area. For maximum protection, these devices must be properly fitted. The use of mouthguards during practices and games should be encouraged, even in low-risk sports in which their use is not mandated.

Injuries to the facial structures are significant because of their relationship to neurological function, the potential for permanent physical deformity and disability, and, in the case of throat injuries, the threat of a compromised airway. An accurate evaluation of injury to these areas is necessary to determine severity and initiate appropriate treatment and management immediately, lessening the probability of any long-term consequences.

Clinical Anatomy

The face is formed by the frontal, maxillary, nasal, and zygomatic bones (Fig. 19-1). Comprising a large portion of the anterior face, the maxilla forms a portion of the inferior orbit of the eye, nasal cavity, and oral cavity. The superior row of teeth is fixed within the alveolar process along the inferior border of the maxilla. The zygoma is fused to the maxilla anteriorly and the temporal bones posteriorly, forming the prominent zygomatic arch beneath the eyes. Providing the cheek with its surface structure, disruption of the zygomatic arch can drastically affect the face's physical appearance. The zygoma also plays an important role in ocular function by forming a portion of the lateral and inferior rim of the eye's orbit.

FIGURE 19-1

Bony anatomy of the face and associated skull.

Anteriorly, the body of the mandible forms the chin. Diverging laterally from the point of the chin, the ramus of the mandible begins at the angle of the jaw and continues its course posteriorly and superiorly. The convex mandibular condylar processes are located at the end of the ramus, forming the inferior aspect of the temporomandibular joint (TMJ). Anterior to the mandibular condylar process is the site of attachment of the temporalis muscle, the coronoid process. Injury to the mandible can potentially involve the alveolar process and thus affect the occlusion of the teeth.

Temporomandibular Joint Anatomy

The TMJ is a synovial articulation located between the mandibular condylar process and the temporal bone. Pathology to the TMJ can result in malocclusion of the teeth and is often cited as the cause of headaches, cervical muscle injury, and overall muscle weakness.1,2 Correction of the malocclusion with specially formed mouthpieces has been suggested to solve these problems.

Movement at the TMJ is necessary for communication and the mastication of food. The superior temporal articulation, from anterior to posterior, consists of the articular tubercle...

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