Author: Eric Schmidt, MD
Senior Editor: Drew Duerson, MD
Editor: Meredith Ehn, DO, DPT

Patient Presentation:
A 20-year-old female soccer goal keeper presented one day after sustaining trauma to the head and face during a game.

History:
A 20-year-old female soccer goalie presented the day after a game during which she sustained trauma to the head and face. An opposing player's knee directly impacted the right side of her face. She did not lose consciousness. She reported initial symptoms of right sided headache, photophobia, and nausea without emesis or dizziness. The sideline physician diagnosed her with concussion and she was instructed to sit out for the remainder of the game. At her clinic appointment the following day, she reported resolution of nausea and dizziness. However, she had developed a black eye and swelling of the right infraorbital region. She endorsed right sided facial numbness, right temporomandibular joint pain, trouble opening her jaw, and trouble chewing. She denied blurry vision, other visual abnormalities, ear or nose drainage. She had no prior history of concussion or facial trauma.

Physical Exam:
Vitals: 133/88, 70, 180 lb., 5'8"
General: She was well appearing and in no acute distress.
Head, Eyes, Ears, Nose, and Throat: Inspection revealed ecchymosis and edema of the right infraorbital region. Pupils were equal, round, and reactive to light. Extra ocular movements were intact without nystagmus or pain. Vestibular ocular motor screening did not elicit any symptoms of concussion. There was tenderness to palpation over the right temporal and zygomatic bones. There was no tenderness over the mandible. She demonstrated difficulty with jaw opening. She had no observed dental or gingival trauma. Her nose was non-tender and without evidence of trauma. Examination of her ears was normal. There was no evidence of cerebral spinal fluid leak.
Neurologic: There was decreased sensation along the right V2-V3 nerve distributions. Cranial nerves II-XII were otherwise intact. Her peripheral neurologic exam was normal with 5/5 strength and symmetric sensation throughout all four extremities.

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