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Woman receiving care for a facial injury

Douglas Hammond – Facial Injuries in Sport – Injury rehab Network

The December Injury Rehab Network event with BASRaT featured a presentation from Doug Hammond. The online event took place on the evening of Wednesday 4th December with 180 sports rehabilitation practitioners in attendance.

Doug discussed facial injuries in sport. The recording is available to watch here

Douglas Hammond

Douglas Hammond, Consultant Maxillofacial Surgeon

Doug qualified in dentistry at the University of Wales in 2000, and later in Medicine at The University College London in 2007.

Doug is a Consultant Maxillofacial Surgeon. He is capable of managing all dental alveolar surgery (wisdom teeth, extractions, sedation of all complexity) and is a highly experienced implant surgeon. He is also a skin cancer surgeon and manages traumatic injuries. As such, Doug is very capable of managing any minor skin operations which might be required on any site of the body, including cyst removal, skin cancer and scar revision.

Doug has worked in professional, elite, and international sport as a doctor since 2009. He has worked across rugby union, rugby league and cricket, with both male and female teams/athletes.

Doug has a strong research background including his PhD and is national specialist research lead. Doug supervised and continues to supervise successful PhD students, mainly associated with Concussion and Computational modelling of fractures/ biomechanics. Doug has more than forty peer reviewed publications.

Doug has been involved in setting national sporting guidelines with concussion.

Doug has previously worked as the Head Doctor at Stoke City FC and is the first team Doctor for the England Rugby League team.

When not in work Doug is an avid follower of sport, and enjoys keeping fit, reading, and spending time with his wife and five children.

Woman receiving care for a facial injury

Facial Injuries in Sport

Doug commenced the presentation by outlining the scope of the topics covered including;

  • Mandible – Condyle
  • Mandible – Classic
  • Zygomatic complex
  • Orbital complex
  • Rarer fractures

Doug discussed his background where he has over 15 years’ experience in sports medicine including work with England Rugby League, Warrington Wolves and Stoke City FC. Doug recommends the British Journal of Oral and Maxillofacial Surgery article “Elite and Professional sports facial injuries management – a consensus report”.

Case Management – Condyle

For condyle injuries, Doug described how intermaxillary fixation screws are used. Doug considered return to play which can be remarkably soon with players often returning 3 weeks post injury with screws still in situ.

Doug discussed the options for case management of condyle injuries which include a conservative approach, open reduction internal fixation (ORIF), and intermaxillary fixation.

Case Management – Mandible Injuries

Doug considered mandible injuries including initial management, assessment of ABC (airway, breathing, circulation), oxygen, clinical assessment, video review, analgesia, and a first dose of antibiotics which should be given within 30 minutes of injury.

For a fractured mandible Doug described how he would phone ahead to the emergency department and organise initial radiographs.

In the case study presented the athlete had suffered a bilateral fractured mandible and was admitted to hospital nil by mouth. An operation was completed the following morning using the ORIF technique, with four plates fixed with monocortical screws. Doug then closes the incision intra orally with vicryl sutures and extra orally with prolene sutures. The patient was discharged from hospital, 24 hours post operation.

For days 1-3 post operation Doug prescribes analgesia, antibiotics and nutritionist support. For days 3-7 post operation Doug advises a soft diet. Athletes can begin exercise with cycling and alter g running. The sutures are then also removed at this point.

For days 7-14 post operation Doug recommends that athletes return to weight training (no jaw clenching), all aerobic activity, and restart skills and drills (non-contact). A concussion assessment is repeated at this time. During days 14-21 post operation Doug recommends there is a discussion of risk stratification to consider priorities for the safe return to play/ competition. At this point the athlete can return to weight training, restart contact in training and may be available to play around 21 days from injury.

Case Management – Zygomatic Complex

Doug described clinical signs of injury to the zygomatic complex including flattening of cheek, periorbital haematoma/ odema, subconjunctival haemorrhage, epistaxis, paraesthesia, interference with mandibular movement, and deranged occlusion.

In the case presented by Doug the athlete was a footballer with injured zygoma and nasal bones.

Case Management – Orbital Complex

Doug considered orbital fractures and orbital floor fractures.

Doug described how injuries can occur in many sports including rugby, football, netball, cricket, hockey, and boxing.

Doug discussed how face masks are made to protect players when they initially return to play. Doug also described how injuries to nasal bones are corrected with surgery. Face masks are not permitted in rugby. In boxing, athletes are not permitted to return to competition for at least six weeks.

Rarer Fractures

Rarer/ unusual fractures should also be considered, and Doug described Le Fort 1 fractures together with other unusual fractures including the frontal bone.

Take Home Messages

Doug shared some take home messages for practitioners with the following advice:

  • Fix if you can fix
  • Primary fixation
  • Nutrition
  • Keep the conditioning as best you can
  • Mitigate with masks
  • Risk stratification
  • How brave are they?

Q&A

Doug kindly answered questions put forward by practitioners who attended the session. Please see the presentation recording for the insights from Doug to the questions.

Presentation Recording

The recording of Doug’s presentation is available to watch here

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