Sports Injuries: From the Manchester Monarchs to Youth Sports
As a member of the medical staff for the Manchester Monarchs of the American Hockey League since the team’s inception in 2001, I have seen the full gamut of facial injuries.
In general, the number of injuries, ranging from broken bones to dental injuries has significantly decreased through the introduction of protective equipment.
Some equipment, like visors, are now required in the AHL, while others, like mouth guards, are recommended. But make no mistake, hockey is a contact sport by its nature, and injuries will always occur even with protective equipment. Although the vast majority of injuries occurring are orthopedic (predominantly knees and shoulders), there will always be the inadvertent stick or puck to the face. And, yes, there is even the purposeful fist to the face!
While I have seen many facial injuries during my time on staff with the Monarchs, I have also seen them with younger players in youth sports. All need to be treated properly. This is when the oral surgeon comes into play.
The most common facial injuries I have seen with the Monarchs are lacerations. Most of these are small, superficial lacerations and, if the athletic trainer can control the active bleeding with adhesives, the player will usually finish playing the period and then have the laceration sutured closed in between periods or at the end of the game.
If active bleeding cannot be controlled, the player will have the laceration immediately repaired by the oral surgeon. Most players sustaining these types of injuries will be able to return to the game after the laceration is repaired. Larger, more involved lacerations need to be repaired immediately, either in the trainer’s room or at the hospital, depending on the extent of the laceration. These lacerations may take more than an hour to repair and can prevent the player from returning to the game.
Hard tissue injuries (broken bones) do occur, but far less frequently than lacerations. These are often caused by much larger forces like falling into the boards, being struck directly by a slap shot or being on the receiving end of a hard punch. The injured player will be evaluated by the oral surgeon in the training room. Any suspected fractures of the jaws or facial bones are sent to the hospital where x-rays will confirm or deny the evidence of the broken bone. These injuries are always repaired in the hospital operating room under general anesthesia and oftentimes necessitate missing an extended period of playing time. Once the player heals from their surgical procedure, they’ll often return to play with a protective cage or shield attached to their helmet, similar to the ones worn by youth hockey players.
Dental injuries can occur in a variety of forms. Teeth can be chipped, fractured, displaced or completely avulsed – in other words, knocked out. Teeth that are chipped, but not displaced are oftentimes taken care of the following day by the team dentist. On the other hand, teeth that are severely fractured and have exposed nerves require immediate treatment. The player will have to have the fractured tooth/teeth numbed with a local anesthesia and have the exposed nerves covered or removed. The tooth/teeth will either be restored or removed during a follow up visit with the dentist or oral surgeon.
Displaced teeth require immediate treatment by the oral surgeon. Displaced teeth prevent the player from properly bringing their teeth and jaws together. Displaced teeth require immediate local anesthesia so that they can be manually reduced (returned to their original position with hand pressure) and stabilized. Stabilization consists of applying some type of a splint to hold the displaced teeth back in their original position. These teeth will always require long-term follow-up care.
Similarly, completely avulsed teeth require immediate treatment. A tooth that is completely avulsed can be returned to its original position and stabilized successfully if done immediately. Success of avulsed teeth being returned to their original position is determined in large part by the length of time from when the tooth was knocked out to the time when it was replaced and stabilized. There are other factors that come into play, like how the tooth was handled and transported (we have standard media to transport teeth) and the age of the patient, but having a well-trained oral surgeon or dentist present who can properly return the tooth to its original position and stabilize it as soon as possible after the injury will likely be the determining factor in whether or not the player will be able to save his injured tooth or will lose it!
Then there are the extreme cases, like one involving Dustin Brown during his time with the Monarchs. Brown is now captain of the Los Angeles Kings, but back in 2004, he started his professional career as a teenager with the Monarchs. Even then, we saw the kind of toughness and grit he had.
Most professional hockey players I have dealt with would not allow a “minor” inconvenience like having a tooth knocked out or their face cut by a stick keep them for trying to help their team win a game. On many occasions, a player has asked me “not to freeze it” (numb up their cut or laceration), just stitch the cut so they could get right back into the game. Brown took it to another level.
The forward smacked his mouth into the boards during a game, knocking a five-tooth bridge loose and snapping off some of the remaining roots of the teeth that were still embedded in his upper jaw and attached to the bridge. When he came back to the bench, his mouth was a bloody mess. I removed all the broken pieces in his mouth and he went back in and played the rest of the game. After the game, I removed the snapped off roots.
That’s what I call hockey player mentality.
Dr. Mark Hochberg is a Diplomate of the American Board of Oral and Maxillofacial Surgery. He has also earned Fellowship status from the American Association of Oral and Maxillofacial Surgeons, the American Dental Society of Anesthesiology and the International Congress of Oral Implantologists.