Professor Iain Hutchison – Sporting Facial Injuries and Treatment Delivering Speedy Recovery – Injury Rehab Network Event

The year’s final Injury Rehab Network event featured Professor Iain Hutchison, Oral and Facial Surgeon.

Professor Hutchison’s presentation discussed facial injuries in sports. Ninety-five sports medicine and rehabilitation professionals from the UK and worldwide joined live for Iain’s presentation, which considered the treatment and rehabilitation of sporting facial injuries.

Professor Iain Hutchison (Oral and Facial Surgeon – Saving Faces)

Professor Iain Hutchison treats patients with diseases, deformities and injuries affecting the most socially important part of our bodies – the face.

In 2000, Professor Hutchison launched the Saving Faces Art Project, which charts the physical and emotional journey of facial surgery patients. The Saving Faces Art Project has dramatically affected the public and has proved cathartic for the patients who participated. The paintings continue to tour the world and have been seen by over two million people.

He wants to demystify medicine and has participated in many TV and radio programmes about facial surgery. Several of his lectures are available for viewing on the internet, including a TED talk entitled “Saving Faces “. Furthermore, Professor Hutchison organises free public events to demystify specific topics such as face transplantation and tissue engineering.

Professor Hutchison wants to improve patient treatment through clinical research. In 2000, he founded the charity Saving Faces, which leads international multi-centre clinical trials on facial disease and injury prevention and treatment. In October 2019, Saving Faces published the first nationwide mouth cancer surgical research, the SEND study, which will save the lives of 30,000 patients worldwide every year, that is one patient saved every 15 minutes. Through Saving Faces, he runs an “Expert Patient” support group for people starting treatment. In addition to this, the Saving Faces Diagnostic Advice Service (SFDADS) provides doctors and dentists with expert diagnostic advice from a consultant Oral and Maxillofacial Surgeon within three working days. This rapid response provides reassurance quickly for those with benign diseases and immediate referral to those who need it to the best cancer surgeons in their nearest hospital.

He also founded the world’s only National Facial, Oral and Oculoplastic Research Centre (NFORC), which launched in 2014. Through its research, NFORC will revolutionise treatment for patients with facial diseases, deformities, and injuries worldwide. He also encourages surgeons to introduce clinical research into their day-to-day practice.

Professor Hutchison wants to inspire and train the doctors of the future and funds PhD students and surgeons in studies on cancer stem cells, the molecular biology of precancer and cancer, and the psychological aspects of facial disease and injury. In addition to this, he also trains research assistants in clinical research and has set up a tissue bank for future basic science studies. Professor Hutchison also gives frequent careers talks in schools and universities and is highly demanded as a scientific and public lecturer.

Sporting facial injuries and treatment delivering speedy recovery

Professor Hutchison’s presentation “Sporting facial injuries and treatment delivering speedy recovery” discussed facial injuries in sports, treatment and rehabilitation, including examples of how athletes can often return to sports soon after surgery.

Iain commenced his presentation with a summary of his experience and roles in relation to facial surgery and sport, where he has worked with professional football and rugby clubs and at international/ elite sports. Iain is the Director of the National Facial and Oral Research Centre and of the Saving Faces Facial Surgery Research Foundation.

Professor Hutchison was a keen water polo player and participated in world student games. As a surgeon, Iain has worked to challenge the rigid thinking that can surround post-operative recovery and return to play from facial injuries.

Why do we do sport?

Iain considered why we do sport, including the psycho-social factors and influences:

• Pleasure/ recreation/ exhilaration
• Fitness
• Relaxation
• Social
• Mental Health
• Competition
• Fame
• Income source

The Scale of Facial Injuries

Professor Hutchison discussed the scale of facial injuries and the sources of data available. Iain attempted to collect data on football, but this was challenging due to the range of competing priorities at football clubs.

The National Facial Injury Survey shows there are around 44,000 sporting facial injuries each year, with around 10% of injuries (over 4,000) being severe. Ninety percent of injuries are in under 30s, and 68% of patients treated with facial injuries are male.

Iain considered different types of sports and their risk factors for facial injuries, including:

• Combat/ assault – boxing, martial arts
• Physical contact – rugby, football, water polo
• Ball and bat – cricket, squash, hockey
• High speed – skiing, motor racing, cycling
• Weapons – shooting
• Equestrian
• Spectators – can get injured and/ or cause injuries
• Fixed objects – may cause injuries in any sport/ activity

The Face and Mouth Importance

Professor Hutchison described the unique features that make the face and mouth so vitally important:

• Breathing
• Smelling and taste
• Seeing
• Eating
• Verbal communication – speaking and hearing
• Identify appearance and expression
• Peer assessment
• (Protect the brain)
• (Social success)

Iain presented the components of the face, including skeletal scaffold, sinuses, mouth and teeth, nose, brain, special structures, and neuromuscular units. Iain described how the structure of the face also protects the brain, like a crumple zone protects those inside a vehicle by absorbing force.

Sporting Facial Injuries

Professor Hutchison presented case studies of a range of sporting facial injuries and described the injury type and treatment.

High-Speed Injuries

Iain described how high-speed injuries to the face could cause severe craniofacial fractures, tissue loss and lacerations.

Ball and Bat Injuries

Professor Hutchison commented that ball and bat injuries could cause a range of fractures, including:

• Nasal fractures
• Zygomatic fractures
• Orbital floor fractures
• Skull fractures

Assault Sports Injuries

Iain described some of the common injuries from assault sports, including lacerations, nasal fractures, mandibular fractures, and frontal sinus fractures.

Physical Contact Sports Injuries

Professor Hutchison discussed injuries that may occur in physical contact sports, including lacerations, nasal fractures, zygomatic fractures, and mandibular fractures.

Sporting Facial Injury Signs and Symptoms

Iain discussed the signs and symptoms of the following types of sporting facial injuries.

Zygoma

• Flattening of cheek
• Infraorbital nerve anaesthesia
• Diplopia
• Trismus
• Ipsilateral nostril bleed
• (Malocclusion)

Orbital Wall

• Limited eye movement
• Diplopia
• Infraorbital nerve anaesthesia
• OM – hanging drop
• Surgical emphysema
• Late Dystopia
• Late enophthalmos

Iain described how the medial wall and floor is paper thin. The wall breaks, so there is no globe rupture.

Mandibular Condyle

• Pain
• Trismus
• Malocclusion
• Bleeding from ear

Mandibular Body

• Pain
• Numb lower lip
• Bloody saliva
• Malocclusion

Dental Injuries

Professor Hutchison discussed dental injuries and treatment where teeth can often be pushed back and splinted. Iain recommended that for avulsions where the tooth is missing, an x-ray of the chest should be completed to attempt to locate the tooth.

Treatment Advances

Iain considered advances in the treatment of facial injuries with a range of technological developments, including:

• On-site specialist advice
• Dental cartridge syringes
• Cyanoacrylate glue (sweat)
• Subcuticular sutures and tie (practice)
• Steristrips
• Internal fixation/support
• 3D printing
• Microvascular reconstruction

Treatment Aims

Professor Hutchison discussed the aims of treatment, both temporary/short-term and definitive.

Temporary Treatment Aims

• Rapid
• (Relieve pain)
• No permanent harm
• No harm to other competitors/ spectators

Definitive Treatment Aims

• Rapid Treatment
• Rapid recovery
• No short-term harm
• No long-term harm
• Players wishes
• Teams wishes
• (Out of season treatment)

Iain discussed the importance of rapid treatment, where timing is important to ensure there are no delays. Treatment should not wait until healing has started, as with injuries such as a broken nose, it can then be necessary to re-break.

Facial Injury Treatment and Return to Play

Professor Hutchison considered different types of facial injuries, treatment, and time to return to training and physical contact.

Facial Injuries Effects

Professor Hutchison described the effects of facial injuries, including disability, long and short-term psychological issues and pain. Disabilities from facial injuries include:

• Visual, e.g., scars
• temporomandibular joint
• malocclusion
• paraesthesia
• breathing/sinuses
• Teeth
• Emotional

Special Considerations

Iain discussed the importance of treating the patient as well as the injury. In professional sport, there are many considerations, including:

• Player’s position
• Likelihood of repeat blow
• Club situation
• Important games
• Representative games

For professional athletes, the hazards of sport and injury include:

• Disability
• Loss of earnings
• Family distress
• Litigation
• Death

For professional sports teams/ clubs, there are risks associated with injury:

• Performance/ results
• Costs
• Share Price
• Merchandise

Following injury, professional athletes and their clubs/ organisations need to consider avoiding further harm, loss of earnings and potential litigation.

Sports Facial Injuries Issues

Professor Hutchison discussed some of the issues and challenges surrounding sporting facial injuries. It can sometimes be difficult to determine the exact incidence and cause of injury. The impact of the injury in relation to the patient’s morbidity is also unknown. With many treatment options available, it can be difficult to know if the correct treatment has been provided. Finally, tough decisions may be required regarding if a player should be laid-off, and information to support these decisions may not be available.

Injury Reduction

Iain considered some of the options available to reduce facial injuries in sports including:

• Padding of structures
• Padding of participants
• Identifying causes
• Rule changes

Facial Injury Medical Equipment Bag

Professor Hutchison provided a list of medical items to be included in an equipment bag for the treatment of facial injuries.

• Dental syringe
• Dental Cartridges of LA
• Fine dental needles
• 4/0 & 5/o prolene or resorbable sutures
• Antiseptic cleaning and drying agent
• Fine scissors, needle holder, and scalpel
• Cyanoacrylate glue (sweat)
• Subcuticular sutures and tie (practice)
• Steristrips

Sports Facial Injuries – Conclusions

Professor Hutchison concluded his presentation with a summary of the main points covered:

• Have the right equipment by your side
• Treat the patient, not the injury
• Treat effectively with rapid recovery and no harm
• Define incidence, causes and morbidity to athletes and clubs with studies
• Seek to reduce but not eliminate the danger

Q&A

Iain kindly answered questions put forward by the practitioners who attended the session.

Q1. What should you do with a tooth that gets knocked out due to injury?
A1. If possible, quickly clean the tooth and push it back into place, making sure the tooth is in the correct alignment.

Q2. Why did you decide to become a facial surgeon?
A2. After working in A&E and seeing how people often presented in crisis with facial injuries. Following immediate care and treatment, it was possible to reassure patients that they could recover and continue to live their lives. The impact of facial injuries on the emotion of patients became very clear through early experiences in A&E.

Q3. Is treatment available for neurological pain relief?
A3. A fractured zygoma can cause neurological pain, and unfortunately, there is no cure. However, rapid treatment may reduce nerve damage.

Q4. Is it possible to limit the risks of facial injuries in boxing?
A4. The fight should be stopped when the boxer can’t protect themselves.

Follow Professor Iain Hutchison and Saving Faces

• Website – Saving Faces https://savingfaces.co.uk/
• Twitter – @Saving_Faces https://twitter.com/Saving_Faces
• Email – info@savingfaces.co.uk

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