Hard Tissue

These can be divided into 3 areas:

  • The upper face - the frontal bone.
  • The midface - the nose, orbit, zygomatic and maxillary bones.
  • The lower face - the mandible.


  • Look for facial asymmetry. Stand in front of the patient and look for gross asymmetry. From above and behind look down to check the level of the cheekbones.
  • Check for altered sensation bilaterally over the forehead, cheeks and below the lower lip on each side. If there is abnormal sensation suspect a fracture.
  • Inspect for bruising, swelling, lacerations, missing tissue, foreign bodies and bleeding.
  • Inspect the eyes.
    • Examine all eye movements.
    • Assess pupils
    • Check visual acuity (Snellen Chart)
    • Check for a hyphema (blood in the anterior chamber of the eye)
    • Consider the use of fluorescein (if available) to look for corneal abrasion
    • If eye trauma is suspected refer urgently to an ophthalmologist via the emergency department if necessary
  • Inspect the nose.
    • Palpate for tenderness
    • Look for deformity
    • Assess for air movement via both nostrils
    • Look for septal haematoma
  • Ears
    • Inspect for lacerations or swelling
    • Check the tympanic membrane is intact
  • Mouth and Jaw
    • Inspect the tongue and oral cavity including the hard and soft palate
    • Palpate the mandible including the temporomandibular joint (TMJ), looking for mobility or crepitus. Also, look for bruising including intra-orally.
    • Assess for Midface/Le Fort fractures (see below)
    • Assess the teeth. Look for avulsed/missing or loose teeth. Look for dental malocclusion (as the player if their teeth meet together normally for them, when biting on the back teeth). If a tooth has been avulsed, if it can't be found, has it been aspirated?