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[CLINICAL TECHNIQUES]

A Custom Face Mask for Sports

Margot Putukian, MD; Brian K. Prout, CO

Department Editor: William O. Roberts, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 2 - FEBRUARY 2000


Facial trauma is common in contact sports. Fractures of the face, including orbital, zygomatic, and nasal fractures, generally stem from direct blows. After treatment, many athletes are eager to return to practice or competition before their fractures have completely healed. Depending on the sport, this may pose a risk.

Many off-the-shelf facial braces for nasal fractures provide protection and are often used by physicians to allow athletes to return to play safely. Unfortunately, these off-the-shelf products often fit imperfectly and impair peripheral vision, and, in our experience, they are generally not well tolerated by the competitive athlete. We describe a method for making a custom face mask that fits snugly, minimally impairs vision, and is well tolerated.

Prep Work

The nature of the injury and the patient's sport must be taken into account when deciding to make a custom mask for the athlete. Though the design and material used remain constant, the mask can be modified to accommodate different fracture locations and specific sports demands. For example, if the athlete has a nasal fracture, the eye openings can be widened to improve peripheral vision, or if the patient has an infraorbital fracture, the mask can be made to extend toward the mouth to take pressure off the fracture site. Custom face masks are not needed in sports such as ice hockey or football because helmet modifications can protect the athlete. Also, how long the brace is necessary should be considered before a custom mask is made; cost may be a factor if the athlete is near the end of the season. Whether it is safe to have an athlete participate with some form of protection is another issue. Individualized care and physician judgment are essential, and rules vary from sport to sport about what is allowed. The masks are not allowed in rugby and must be padded for use in wrestling. Custom face masks aren't feasible for athletes who wear glasses because the mask must fit closely to the face.

Though making a custom face mask and obtaining the materials are not difficult, an orthotist has the special equipment and expertise to make the orthosis. Ideally, primary care physicians should develop a close working relationship with an orthotist. The physician provides the orthotist with details about the athlete's fracture and demands of the sport, then the orthotist expedites the making and fitting of the mask. Some primary care physicians make the initial negative impression, but most orthotists prefer to handle all steps of mask construction. (For a certified orthotist in your area, contact the American Academy of Orthotists and Prosthetists, 703/836-7118.) Though custom face masks are often more expensive than off-the-shelf models (about $300 vs $25), for the competitive athlete in season the cost is generally well worth it.

Making the Mask

The first step in making a custom mask is to take an impression of the patient's face. It is important to note any swelling or prominent nasal bones before casting so relief can be added to the model in these areas to prevent unnecessary pressure. Place stockinette over the hair and apply petroleum jelly to the face for protection and as a parting agent to ease removal of the negative impression.

Add water to dental alginate until the mixture is the consistency of oatmeal. Use a tongue depressor to spread the alginate mixture on the face from the hairline over the nose to the upper lip (figure 1). It should extend to the front of the ears on both sides. Cover the alginate with plaster bandage to reinforce the mold so that it holds its shape when it is removed. Though the dental alginate is technically sterile, sutures or abrasions that need protection can be covered by a sterile, semipermeable adhesive film such as OpSite (Smith & Nephew Inc, Largo, Florida) or similar plastic covering.

[Figure 1]

After the plaster has hardened (3 to 5 minutes), gradually begin loosening the mold around the edges with a tongue depressor. Remove the cast and immediately form a vessel by extending the borders with plaster bandage without deforming the shape. Sprinkle talcum powder inside the mold for ease of separation.

The orthotist then fills the negative with plaster of paris. Straws are placed in the eyes and nostrils to allow for better seal and replication of those areas. After the plaster has hardened (figure 2), the outer shell (the negative) is peeled from the positive mold and any irregularities are removed.

[Figure 2]

Plaster is added to the mold at sites where pressure relief is needed. A sheet of 1/16-in. clear Uvex plastic is heated in an oven (about 400°F) until it becomes pliable, usually 5 to 8 minutes. The plastic is removed and placed over the mold. A vacuum pump device is applied to the model until the plastic is pulled in tightly.

The mask is trimmed with a cast saw to provide a generous margin above the eyebrows and to extend to the upper lip and about 1 cm anterior to the ears (figure 3). The width of the mask is determined by trimming according to the medial-to-lateral distance just anterior to each ear, leaving enough additional material to accommodate slots for the elastic straps that secure the mask. The straps are often made of elastic material that can be secured by Velcro. Two I-in. slots are cut with a die grinder into each side of the mask for the straps. These should be positioned superiorly and inferiorly to avoid pressure on the ears. If pads are used, contact cement or cyanoacrylate glue is used to attach narrow pads of closed-cell polyurethane foam to the inside above the eyebrows and at the cheekbones so that the appliance is not sitting directly on the face.

[Figure 3]

The holes for the eyes are initially drilled with a 2-in. hole saw and drill press, then widened with a sander so that they are slightly bigger than the eye image from the model. The nostril holes are 1/4 in. to 5/16 in. in diameter, though the mask can be modified so that it does not extend to the nose.

Once the face mask is made, it is checked for proper fit. Minor modifications can be made fairly easily by adding padding or heating and flaring the plastic away from the pressure points. This will help the mask fit correctly, keep pressure off the fracture, and facilitate peripheral vision. For infraorbital rim fractures, the contact points between the mask and face will need to be modified so that the mask comes down a bit lower than for a nasal fracture.

Efficacy and Return to Play

Athletes report excellent success using the mask. Though most of them would prefer to go without a mask, many have reported that the mask helped prevent significant injury when they were struck with a ball or elbow.

Dr Putukian is the director of Primary Care Sports Medicine and a team physician at The Pennsylvania State University in University Park, Pennsylvania. Mr Prout is a certified orthotist with Central Orthotics and Prosthetics in Altoona, Pennsylvania.


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