Facial Injury - Men’s Soccer: 1654 May 28, 2

HISTORY: 19 year old healthy college soccer player who came to came to the sideline with head pain, pressure behind his left eye after being elbowed in the left forehead. He complained of nausea, tiredness, fogginess. He denied loss of consciousness. He mentioned to the coach, “It feels like I have a dent in my head.” He described pain behind left eye with lateral gaze. As sideline evaluation continued, he began having hematemesis. PHYSICAL EXAMINATION: Gen: Slightly dazed appearing, answering slowly but appropriately, no decreased level of consciousness. HEENT: L forehead with sulcus, painful to palpation, just over eyebrow. PERRL, EOMI but pain with leftward lateral gaze. Gross visual acuity and visual fields intact. Nares without trauma or bleeding. Oropharynx clear. TMs clear. Neck: Full ROM, no midline tenderness to palpation. DIFFERENTIAL DIAGNOSIS: 1. Facial fracture 2. Intracranial bleed 3. Ocular injury 4. Concussion 5. Facial contusion TESTS AND RESULTS: Non-contrast CT head: Mildly displaced left frontal sinus fractures associated with soft tissue swelling. Non-displaced fracture extending through the roof of the left orbit associated with some intraorbital gas. No acute intracranial abnormality. FINAL WORKING DIAGNOSIS: 1. Depressed Frontal Sinus Fracture 2. Superior Orbital Fracture 3. Concussion TREATMENT AND OUTCOMES: 1. Placed on prophylactic antibiotics, referred to ENT for surgical management 2. Open reduction and internal fixation of fracture 3. Concussion management including return to cardiovascular exercise at two weeks when cleared by surgeon for this activity 4. Expected return to contact sports at 3 months (+/- mask)