LeBron James and His Broken Nose

LeBron James suffered a broken nose. He first broke it Feb 2014 when playing against Oklahoma City. He than got hit to the nose again (while wearing a mask) when playing against Houston in March 2014. [link]

Regardless of whether you are an NBA player or not, treatment of most nasal and even facial fractures do NOT require surgical repair.

The key elements that lead towards a decision for facial and/or nasal fracture surgery are the following (not all-inclusive, but general pointers):

- Any functional deficit (i.e., inability to open and close the jaw)
- Change in occlusion (the way teeth come together).
- Double vision (blurry vision does not count).
- Cosmetic deformity due to nasal/facial fracture (bruising and swelling does not count).
- Nasal obstruction not due to swelling.

In any case, when a nose is broken, steps should be taken to further minimize trauma to the nose. For athletes, that usually means wearing a facial mask such that any hits to the face does not connect with the broken nose.

Although LeBron James had his facial mask custom made by Marvel, for us mere mortals, you can buy one on Amazon.

Source:
Just like every other superhero, LeBron has his Kryptonite. Fox Sports 3/5/14

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Bengals Punter Kevin Huber Suffers Jaw Fracture During Game

Courtesy of Jeffrey Beall from Wikipedia

This past weekend, Cincinnati Bengals punter Mark Huber suffered a broken jaw when he was viciously knocked to the ground by Steelers Terence Gavin who lead the tackle with his helmet. [link]

Given bleeding from the mouth, there is the possibility of an open fracture extending into the mouth, though it could also be from a self-inflected bite when Huber got hit.

Unlike most facial fractures that do NOT require any surgical intervention, most jaw fractures do need to be surgically repaired and typically entail wiring the jaw shut. Often, a metal plate with screws will be utilized to stabilize the fracture as well.

The reason the jaw is wired shut is so that as the broken bone heals, it heals in such a way that the way the teeth comes together is normal (in essence, the teeth act as the cast for the jaw fracture). Of course, eating is limited to liquid diet and dental care is important as brushing the teeth thoroughly will be impossible.

Also, it is easier to precisely place the metal plates after the jaw is wired shut. In Huber's case, metal plates will almost certainly be utilized as it allows for faster healing, sooner removal of jaw wiring, and quicker return to normalcy.

The wires holding the jaw shut can be removed after a few weeks, but exact duration depends on the fracture location and severity.

With this type of facial fracture, it will be unclear when exactly he will be able to return play.

Source:
SEE IT: Bengals punter Kevin Huber fractures jaw after taking hit from Steelers' Terence Gavin. NY Daily News 12/15/13

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Actor Zac Efron Broke His Jaw

Image by Liam Mendes from Wikipedia

This past weekend, actor Zac Efron slipped in a puddle of water outside his home and fell resulting in a severe facial cut as well as a broken jaw. [link]

Unlike most facial fractures that do NOT require any surgical intervention, most jaw fractures do need to be surgically repaired and typically entail wiring the jaw shut. Often, a metal plate with screws will be utilized to stabilize the fracture as well.

The reason the jaw is wired shut is so that as the broken bone heals, it heals in such a way that the way the teeth comes together is normal (in essence, the teeth act as the cast for the jaw fracture). Of course, eating is limited to liquid diet and dental care is important as brushing the teeth thoroughly will be impossible.

The wires holding the jaw shut can be removed after a few weeks, but exact duration depends on the fracture location and severity.

Source:
Zac Efron broke his jaw this weekend. CNN 11/13/13

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Cheerleading A Dangerous Sport from an ENT Perspective

The American Academy of Pediatrics (AAP) published its first policy statement regarding cheerleading due to the increasing rate of injuries found in this increasingly competitive sport.

Who knew that although the overall risk of injury is lower than other sports, it has one of the highest rates of catastrophic injuries including closed-head injury, skull fractures, cervical spine injuries, paralysis, and even death.

After all, cheerleaders do not wear protective gear and safety is utterly dependent on external factors such as spotters and floor protection.

From an ENT perspective of a solo private practice, cheerleading is one of the leading causes of facial fractures in a student population.

Such fractures include nasal bone and orbital blow-out fractures sustained from elbows and other flying limbs.

Although AAP made 12 recommendation to make this sport safer, I was going to suggest that all cheerleaders should wear face-guards to minimize risk of facial trauma.

Here's one called Mueller Nose Guard. Available for purchase on Amazon.com.

Reference:
Cheerleading Injuries: Epidemiology and Recommendations for Prevention. Pediatrics 2012;130:966-971.

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US Gymnast Maroney Suffers Nasal Fracture

World vault champion McKayla Maroney on the US gymnastics team suffered a nasal fracture during pre-meet training when she over-rotated at the end of a tumbling run and fell hard earlier this month. She also suffered a concussion. A visit to the ER revealed her injuries. Apparently no surgical intervention was pursued.

This case illustrates that most nasal and even facial fractures do NOT require surgical repair.

The key elements that lead towards a decision for facial and/or nasal fracture surgery are the following (not all-inclusive, but general pointers):

- Any functional deficit including inability to open and close the jaw.
- Change in your occlusion (the way your teeth come together).
- Double vision (blurry vision does not count).
- Cosmetic deformity due to nasal/facial fracture (bruising and swelling does not count).
- Nasal obstruction not due to swelling.

The two main specialties able to assess whether surgery is required or not is ENT and Plastic Surgery as well as some oral surgeons.

Source:
Maroney suffers concussion, nasal fracture. ESPN 6/10/12

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Dental X-rays Linked to Brain Tumors

In a study spanning over decades, researchers have found an association between dental x-rays and increased risk of a non-malignant type of brain tumor called meningioma.

Of the four types of dental x-rays, only the full-mouth series was associated with this increased risk. More specifically, the risk was elevated with the aggregate number of full-mouth series in 10-year periods from approximately 15–40 years before diagnosis, with significant elevations in the 10-year periods beginning 22–30 years before diagnosis. The risks in these analyses were even greater when only women were considered.

One needs to be aware that radiation exposure from full-mouth series was much greater in the past than it is now and as such, this risk may be nominal (though not zero) with current dental x-ray technology.

However, it also should be a reminder that x-rays should not be routinely performed unless there is a very good reason to obtain especially in children who are more susceptible to radiation injury... and that applies to not only x-rays, but any kind of testing involving ionizing radiation including CT scans.

Some x-rays should NEVER be performed including sinus x-rays for sinus problems given a nearly 50% error rate in diagnosing the presence OR absence of sinus problems.

X-rays for nasal fractures is not recommended given x-rays rarely change how such fractures are managed.

Soft-tissue lateral x-rays to look for large adenoids should also be discouraged as nasal endoscopy can provide similar if not better information without any radiation exposure.

To know what the cancer risk is with different types of x-rays, check out this website!

Source:
Dental X-rays and the risk of intracranial meningioma. Cancer. Volume 100, Issue 5, pages 1026–1034, 1 March 2004

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Strong Sneeze Broke Woman's Neck

Fox News reported yesterday about an Australian woman, Monique Jeffrey, who sneezed SO hard that she broke her neck... literally.

According to the neurosurgeon the patient eventually saw, her C1 and C2 vertebrae had dislocated and were displaced which resulted in her symptoms of excruciating pain with her head locked to her right shoulder and in too much pain to move anything but her right arm. Her left arm was also numb with tingling.

She was placed in a halo traction for three months with weights to gradually move the vertebrae back in alignment.

Source:
Super-strong sneeze puts mom in traction for three months. Fox News 3/27/12

Melbourne mum dislocates neck by sneezing. 9 News Melbourne. 3/27/12

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New Webpage on Facial Fractures and Nasal Fractures

Our office has created a new webpage describing the evaluation and management of not only nasal fractures, but also facial fractures.

Fracture types discussed include:

• Nasal Fractures
• Orbital Fractures (around the eye)
• Maxillary Fractures (cheek)
• Zygomatic Fractures (behind cheekbone)
• Tripod Fractures (cheekbone)
• Mandible (lower jawbone)
• LeFort (upper jawbone)

Check it out here!

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