Bleeding, Fractures and Difficulty Breathing: The Truth Behind World Cup Masks

The masks on the faces of World Cup players may look like a symbol of toughness, but behind them sometimes hide complex injuries to the nose, jaw and facial bones. The blows usually come from heads, elbows and shoulders, can affect breathing and hide damage that is not revealed immediately. Sports doctors and ENT explain who is at risk, what must be checked already on the grass and when a quick return to the game may cost dearly

Recently this sight has become more common on World Cup pitches: players stepping onto the field with a protective mask covering part of their face. In the 2026 World Cup, England's Jadon Spence, Austria's Stefan Posch and Algeria goalkeeper Luca Zidane were seen this way after suffering jaw or facial bone injuries. They were preceded by Kylian Mbappe, who played with a mask at Euro 2024 after breaking his nose, and Croatia's Josko Gvardiol, who wore a protective mask at the 2022 World Cup.

This striking image shines a spotlight on a type of injury that usually stays outside the conversation about soccer dangers: bruises and fractures to the facial bones. They may receive less attention than anterior cruciate ligament tears or muscle injuries, yet they can conceal significant damage and even lead to surgery months after the initial blow.

"Facial and head injuries are not the most common in soccer, but they certainly occur," says Dr. Lior Leber, chief physician of the Israel Football Association and director of the sports injury and arthroscopy service at Hillel Yaffe Medical Center. Contrary to what one might think, the ball itself is rarely the cause. "The more frequent incidents are collisions between two players jumping for a high ball, a clash between a player and the goalkeeper, two heads colliding or an elbow striking the face," explains Dr. Leber. "Sometimes a player jumps for a high ball, another comes underneath, he loses his footing and lands on his head, but this mechanism is less common."

The risk is not shared equally among players. "On corner kicks or high balls into the box a large concentration of players jump together," says Dr. Leber. "Goalkeepers and central defenders face higher risk than other players because they are involved more frequently in situations where they jump for high balls with others and also tend to dive toward opponents' legs more often - whether in a tackle, slide or jump as a goalkeeper."

Injuries can involve almost any area of the face. "We encounter orbital fractures, jaw fractures and injuries to the temporomandibular joint that can dislocate or subluxate," details Dr. Leber. "There are also dental fractures and, of course, nasal injuries, which are perhaps the most common. The nose protrudes from the face, making it easier to strike in a head-to-head collision, elbow or other blow."

The type of mask is tailored to the injured area and the level of protection the player needs. "Some masks protect the nose more, others protect different facial areas, and some guard the jaw and lower facial bones better," says Dr. Leber. In the vast majority of cases, mask use follows an injury. Sometimes the player has already healed but still fears re-injury and does not feel safe enough to play without protection.

Dr. Lior Leber: "In head injuries we take no risks. We allow the team doctor to assess and rule out concussion on the spot, and sometimes this takes two to three minutes or more. Even if there is doubt, current guidelines are very strict and require removing the player from the game entirely"

One well-known example of goalkeepers' elevated head-injury risk is Petr Cech, former Czech Republic and Chelsea goalkeeper, who suffered a skull fracture early in his career that required surgery and played for years with a helmet. "He wore a soft helmet similar to those used in rugby, which at least partially protected him from further impacts."

Yet in facial trauma the fracture itself is not always the most immediate danger. Because of proximity to the head and the violent mechanism of impact, medical staff must also rule out concussion early. "This is one of the most important things that must be done on the pitch," emphasizes Dr. Leber, "beyond checking for fracture or stopping bleeding if present."

When head injury is possible, he says, the player's own feelings or desire to continue are not enough. "In head injuries we take no risks. We allow the team doctor to assess and rule out concussion on the spot, and sometimes this takes two to three minutes or more. Doctors receive training to perform the diagnosis quickly and efficiently. FIFA also emphasizes this and instructs referees to allow the initial pitch-side assessment."

If concussion cannot be ruled out, the player does not return. "Even with doubt, current guidelines are very strict and require removing the player from the game entirely," says Dr. Leber. "Afterward there are structured protocols we follow before allowing return to play."

Facial injuries are more than dramatic sights on the pitch. They can hide fractures, septal damage and ongoing harm. The nose, prominent in the center of the face, is usually first to absorb the blow, and even trauma that does not look especially severe can cause significant bleeding and internal damage.

"The nose consists of small bones connected together, cartilage, highly vascular tissue and many nerves," explains Dr. Snir Bar, an ENT physician at Maccabi Healthcare Services. "These structures can fracture relatively easily, even in very large and strong players, and bleed readily compared with other organs.

"Limb injuries can be very severe, yet we almost never see blood. In contrast, even a minor blow to the nose can cause heavy bleeding." Weather conditions can also affect bleeding severity, especially in the current World Cup where extreme heat has frequently made headlines. "We see a tendency toward heavier nasal bleeding in hot, dry weather," says Dr. Bar.

Yet the amount of blood does not necessarily indicate injury severity. Externally one may see swelling, bleeding or crookedness, but often the main damage lies inside the nose. The nasal septum, the cartilaginous wall separating the nostrils, plays a central role in airflow, and any injury can alter breathing long after the initial trauma has passed.

"Healthy people breathe through the nose in a cyclic pattern," explains Dr. Bar. "They mainly use one nostril at a time while the other undergoes maintenance. Healthy people do not notice this. I can ask someone which side they are breathing through and they may not know. If the septum deviates to one side it can obstruct one nostril," he says. "A person with deviation to one side may sometimes feel blockage on both sides or only on one."

Dr. Snir Bar: "There can be a fracture that barely changes the external appearance of the nose yet creates internal septal curvature and causes breathing difficulty. Breathing matters to everyone, but certainly to elite athletes"

Even then the problem is not always felt immediately. "Sometimes people receive a blow to the septum and initially feel nothing," says Dr. Bar. "Only later do they develop nasal breathing difficulty and do not quite understand why. Sometimes the complaints do not even match the injury location or the direction of septal deviation."

The external appearance of the nose, and even the presence of a fracture, do not necessarily reflect injury severity. "Nasal fractures can have no clinical significance," says Dr. Bar. "An X-ray may show a fracture, but if the nose remains straight, the septum does not obstruct airflow and the person breathes well, treatment may not be needed."

The opposite is also possible. "There can be a fracture that barely changes the external appearance of the nose yet creates internal septal curvature and causes breathing difficulty," he explains. "Breathing matters to everyone, but certainly to elite athletes. Conversely, there can be external deformity without functional impairment, and there can be a combination of both."

A player who does not yet feel significant difficulty may still be vulnerable to another blow that worsens the damage. This is one reason protective masks are used during recovery. "Even a small blow could aggravate the problem, even if he feels nothing in the first days," explains Dr. Bar. "Therefore we tend to protect players and provide a device that attempts to cushion further impacts or minor traumas that could worsen the condition."

Yet recurrent injury is not the only danger that may lurk in the days after impact. One of the most important and urgent complications to rule out is septal hematoma, accumulation of blood around the septal cartilage that can compromise its blood supply and lead to irreversible damage.

"This occurs when a blood vessel near the septum is injured, creating an area filled with blood that surrounds the cartilage," explains Dr. Bar. "Cartilage lacks its own direct blood supply, so accumulated blood can damage and break it down." Such injuries are problematic because they do not always appear immediately. If missed and the cartilage remains encased in a blood-filled space, it can disintegrate and destroy the nose's shape," says Dr. Bar. One possible deformity is a saddle nose, in which the nasal bridge collapses and sometimes later requires reconstructive surgery.

Although the nose lies in the front line of collision, strong blows to the face and head can also affect the ears and, more rarely, structures in the throat area. An auricular hematoma, accumulation of blood around the cartilage, can form in the pinna and follows a similar mechanism to septal hematoma.

"This injury is more common in wrestlers and MMA fighters, but it can occur after a strong blow in other sports," explains Dr. Bar. "The auricular cartilage becomes surrounded by blood and may gradually necrose. The ear folds inward, the skin and tissues fold with it, and the pinna loses its familiar shape. There is a relatively limited window of about one to two weeks," he says. "If untreated it can take on the appearance of a crushed cauliflower."

A strong blow can also reach deeper into the ear. "I have seen several cases of tympanic membrane perforation caused by impact," recounts Dr. Bar. "This can impair hearing and later cause ear infections. In most cases the perforation closes spontaneously, but follow-up is required." Throat injuries are much rarer yet still possible. "The throat area contains bone, cartilage and structures connected to the trachea and muscles involved in speech," explains Dr. Bar. "Fractures in this region are very rare in sport, but isolated cases occur."

Ultimately the mask on a player's face may convey determination and a desire to return quickly to the pitch, yet it also serves as a reminder that behind the bleeding and swelling complex damage may lie hidden. Precisely because some injuries are not felt or seen immediately, accurate diagnosis, monitoring and protection from further impact can determine whether the trauma resolves without consequences or continues to affect the player long after the final whistle.