DEFINITION--Bruising of skin and underlying tissues of the face caused by a direct blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons or other soft tissue. The face is particularly vulnerable to contusion because skin is so close to hard, underlying bone. (Note: Contusions and other injuries of the eyes, nose and ears require special considerations and care. They are addressed separately in this book.)
BODY PARTS INVOLVEDFace tissues, including blood vessels, muscles, tendons, nerves, covering to bone (periosteum) and connective tissue.
SIGNS & SYMPTOMS
Local swelling at the contusion site. The swelling may be round or egg-shaped and superficial or deep.
Pain and tenderness over the injury.
Feeling of firmness when pressure is exerted on the injured area.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
CAUSESDirect blow to the skin, usually from a blunt object.
RISK INCREASES WITH
Violent contact sports such as boxing or hockey, especially if the face is not adequately protected. Also common in baseball and fencing.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTWear an appropriate face mask during competition or other athletic activity if a face contusion is likely.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the contusion is quite small.
Self-care for minor contusions.
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the facial area to rule out the possibility of underlying fracture. The total extent of injury may not be apparent for 48 to 72 hours.
Excessive bleeding. Infiltrative-type bleeding can (rarely) lead to calcification and impaired function, and facial disfiguration.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin over the contusion is broken.
PROBABLE OUTCOMEHealing time varies with the extent of injury, but all but the most serious face contusions should heal in 6 to 10 days.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
REHABILITATIONRehabilitation exercises must be individualized. Follow your doctor's or surgeon's directions.
CALL YOUR DOCTOR IF
You have a face contusion that doesn't improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.