Head and orofacial injuries in sports are common, but serious injuries are rare. At present, there is substantial interest in concussion and its management in sport. Many sports give rise to the potential for the athlete to be struck in the head or face, often by relatively rigid high-speed projectiles or body parts. The bony contours of the face combined with the soft tissue covering makes the face vulnerable to fractures and lacerations when it is exposed to impacts. The dimensions of many projectiles, e.g. squash balls and cricket balls, mean that they can impact the eye or damage the orbit. In the context of the range of normal impacts in team sports, skull fractures are not common. Head impacts against rigid pieces of infrastructure, e.g. posts, concrete footings and hard floors, can give rise to skull fractures. In powered sports or high-speed individual sports, e.g. cycling, skiing and horse racing, the unprotected head is exposed to a measurable risk of skull fracture and severe intracranial injury. The brain, however, is vulnerable to the range of head impact severities that athletes are exposed to in sport, with the most frequent manifestation being concussion. Consensus guidelines on the management of concussion indicate that athletes should not return to match play in the event in which they have been concussed and their future return to play must occur after resolution of symptoms and cognitive function. The application of risk management approaches to prevent head and facial injury is successful. The application of rules that prevent and limit head contact is important. Improving the infrastructure to remove hazards is another element. Personal protective equipment, such as helmets and mouthguards, has been shown in some sports to protect the head and mouth. Immediate medical management of injuries and evidence-based return-to-play processes are also essential.