Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

CHAPTER 22
The Head, Face, Eyes, Ears, Nose, and
Throat
OVERVIEW
Injuries to the head and face can have serious consequences. Brain injuries,
which can be life-threatening, often result from blows to the head or body and can
be classified as concussions. Depending on the severity of the concussion, the
athlete may display signs of disorientation, dizziness, amnesia, headache, loss of
consciousness, problems in concentrating, tinnitus, balance problems, or visual
disturbances. Concussions are categorized into three grades: mild, moderate, and
severe. Returning to competition after a concussion should be the decision of a
physician due to the complications that can occur such as second impact syndrome
and post concussive syndrome.
The face is subject to many different types of traumatic sports injuries. The most
common are facial wounds, with lacerations ranking first. Less common, but more
serious, are injuries such as jaw fractures, dental injuries, nasal injuries, eye injuries,
and injuries to the ear. Facial injuries can often be prevented through the use of
protective equipment such as mouth guards, facemasks, and eye protection. (See
Chapter 6)

LEARNING OBJECTIVES

After studying Chapter 22, the student will be able to:

Identify the bony anatomy of the skull and face.
Describe the special tests performed on an athlete that has a head injury
including eye function, balance tests, coordination tests, and cognitive tests.
Explain the symptoms associated with the different grades of concussions.
Explain the return to play criteria for the different grades of concussions.
Explain the difference between epidural and subdural hematomas.
Explain the significance of second impact syndrome.
Describe the signs and symptoms of postconcussion syndrome.
Describe the cause, signs of injury, and care for facial injuries.
Identify the anatomy of a tooth.
Describe the difference between an uncomplicated crown fracture, complicated
crown fracture, and a root fracture.
Explain how to treat epistaxis in athletes.
Explain how to treat the common injuries of the ear.
Describe the treatment for injuries to the eye including orbital fractures, foreign
body removal, corneal abrasions, hyphema, retinal detachments, and
conjunctivitis.
Describe the treatment for throat contusions.

KEY TERMINOLOGY
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Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

Anterograde Amnesia The inability to remember things that occurred after the
injury
Blowout fracture - Fracture of the very thin bone located in the inferior aspect of
the orbit after a blow to the eye and orbital ridge; caused by the sudden increase
in internal pressure of the eye.
Concussion - Clinical syndrome characterized by immediate and transient
posttraumatic impairment of neural functions such as alterations of
consciousness, disturbance of vision, equilibrium, etc.
Contrecoup Injury An injury to the brain on the opposite side of impact
Coup Injury An injury to the brain on the side of impact
Diplopia - Double vision
Dura mater - Outermost membrane of the brain consisting of a dense, fibrous,
and inelastic sheath that encloses the brain and spinal column
Epidural Hematoma An injury to the brain from a tear in the meningeal arteries
secondary to a blow to the head
Epistaxis Nosebleed
Hematoma auris ("cauliflower ear") - Deformity of the ear caused when trauma
tears the overlying tissue away from the cartilaginous plate resulting in
hemorrhage and fluid accumulation
Hyphemia - Collection of blood within the anterior chamber of the eye as a result
of a blunt blow
Otitis Externa Infection of the ear canal, otherwise known as swimmers ear
Pia mater - Thin, delicate, highly vascularized membrane that adheres closely to
the spinal cord and brain
Postconcussion syndrome - The athlete displays characteristics such as
giddiness, attention difficulties, anxiety, and headaches
Retrograde Amnesia The inability of an individual to recall events that occurred
prior to the time of injury
Second impact syndrome - The brain rapidly swells as a result of a second blow
before the signs and symptoms of the initial concussion have cleared
Subarachnoid space The space between the arachnoid and pia mater
membranes that contains the cerebrospinal fluid
Subdural Hematoma An injury to the brain resulting from acceleration and
deceleration forces and involving venous bleeding

DISCUSSION QUESTIONS
1. Describe the intermediate care procedures that should be performed when a
tooth is fractured or dislocated.
2. Describe the procedures that should be performed for an athlete with a
nosebleed.
3. How can cauliflower ear be prevented?
4. What are the major indicators of a serious eye injury?
5. What are the meninges and what functions do they serve?
6. How should an unconscious athlete be evaluated to rule out a serious neck
injury? How is a serious injury managed?
7. How should a head injury be evaluated to determine the extent of a cerebral
injury?
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Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

8. What are the different levels of concussions? What symptoms and signs occur at
each level? How is each level properly handled?
9. What are the different types of intracranial hemorrhages that can occur? What
symptoms and signs are seen with each type of intracranial hemorrhage? How
rapidly would these signs become apparent? How is each type managed?
10.What are the most common facial injuries? How are they managed? Which facial
injuries may pose a serious threat to the athlete or to one of the athlete's
primary senses?

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Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

CLASS ACTIVITIES
1. Invite an otolaryngologist to discuss injuries common to the ears, nose, and
throat, their management, and what surgical repair may be necessary to treat
these injuries.
2. Invite a neurosurgeon to discuss nerve injuries, cerebral injuries, and
complications from intracranial hemorrhaging. He/she may have access to slides
or radiographs showing the different methods used by physicians to assess
intracranial bleeding.
3. After proper instruction, each student should practice evaluating a cerebral
injury (for both unconscious and conscious athletes) and an intracranial injury.
Each student should be able to assess the situation, test for the extent of injury,
and demonstrate proper management. The student should also know what to tell
the athlete pertaining to the injury.
4. Each student should demonstrate how to care for common facial injuries
including abrasions, lacerations, fractures, and special injuries to the ears, nose,
and teeth.
5. Contrast the grades of concussion.
6. Make up scenarios and talk about when you would return the athlete to activity
and what is the process for making that decision.

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.
5.

q
t
o
p
a

6. f
7. e
8. d
9. j
10. c

11.
12.
13.
14.
15.

k
n
s
g
w

16.
17.
18.
19.
20.

v
b
r
u
l

21. i
22. h
23. m

Matching
24.
25.
26.
27.
28.
29.

j
h
g
k
b
i

30.
31.
32.
33.
34.

c
a
d
f
e

Short Answer
35.Clinical syndrome characterized by immediate and transient posttraumatic
impairment of neural functions such as alterations of consciousness, disturbance
of vision, equilibrium, etc.
36.Otitis externa and otitis media
37.The brain rapidly swells as a result of a second blow before the signs and
symptoms of the initial concussion have cleared
38.The eye should be patched, and the athlete should be sent to a physician.
39.Have the athlete stand with feet together, eyes closed, and arms at their side. If
they lose their balance, cannot keep their eyes closed, or sway excessively, the
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Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

test is positive.
40.Have the athlete sit upright, place a cold compress over the nose and the
ipsilateral carotid artery while applying finger pressure to the affected nostril for
5 minutes. May also place a piece of rolled-up gauze between the upper lip and
gum.
41.Serial 7s and the months of the year in reverse.
42.Attempt to re-implant the tooth. The avulsed tooth can be rinsed off but should
never be scraped or scrubbed to get the dirt off. If it is no possible to re-implant,
store the tooth in a Save a Tooth kit or in milk or saline. Refer athlete to
dentist immediately.
43.A small portion of the tooth is broken but there is no bleeding from the fracture
and pulp chamber is not exposed
44.A portion of the tooth is broken and there is bleeding from the fracture. The pulp
chamber is exposed and there is a great deal of pain.
45.Occurs below the gum line, tooth may appear to be in the normal position but
there is bleeding from the gum around the tooth, and the crown of the tooth may
be pushed back or loose.
Listing
46.Severe headache and nausea
47.Palpable defect such as a skull indentation
48.Blood in the middle ear, ear canal and bleeding through nose
49.Raccoon eyes or Battles sign
50.Cerebrospinal fluid may appear in ear canal and nose
Essay
51-55.In the lower lid, remove by depressing the tissue and then wiping with a
cotton applicator. In the upper lid, Produce tears by pulling the upper lid over
the lower one or use the technique illustrated in figure 22-16, page 362.

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Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

NAME ______________________________
SECTION__________

CHAPTER 22 WORKSHEET
The Head, Face, Eyes, Ears, Nose, and Throat
MATCHING: Match the letter of the structure with the appropriate term.
_____1. Arachnoid
_____2. Cerebral cortex
_____3. Dura mater
_____4. Epidural space
_____5. Frontal bone
_____6. Mandibular
symphysis
_____7. Maxilla
_____8. Nasal complex
_____9. Occipital bone
_____10. Orbit
_____11. Parietal bone
_____12. Periosteum
_____13. Pia mater
_____14. Ramus (mandible)
_____15. Scalp
_____16. Skull
_____17. Sphenoid bone
_____18. Subarachnoid
space
_____19. Subdural space
_____20. Suborbital arch
_____21. Temporal bone
_____22.
Temporomandibular
joint
_____23. Zygoma
MATCHING: Match the conditions with the correct responses.
_______24.
_______25.
_______26.
_______27.
_______28.
_______29.
_______30.
_______31.
_______32.
_______33.
_______34.

Epidural hematoma
Subdural hematoma
Photophobia
Anterograde amnesia
Retrograde amnesia
Tinnitus
Epistaxis
Hyphema
Auricular hematoma
Otitis externa
Diplopia

a. Blood in the anterior chamber of the

eye
b. Unable to recall events before
concussion
c. Nosebleed
d. An injury common to a wrestlers
ear
e. Double vision
f. Condition common to swimmers
g. Sensitivity to light
h. Brain injury due to a venous bleed
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Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

i. Ringing in the ears

j. Brain injury from arterial bleed
k. Unable to recall events after
concussion

SHORT ANSWER
35.What is the definition of a concussion?
36.Name two common ear infections?
37.What is second-impact syndrome?
38.How should you deal with an athlete who may have a corneal abrasion?
39.How is balance tested, and what is considered a positive sign?
40.How would you manage a bloody nose?
41.Name two cognitive tests that can be used on an athlete that has sustained a
head injury.
42.What is the treatment for an avulsed tooth?
43- 45. Define the following types of tooth fractures:
Uncomplicated tooth fracture:
Complicated tooth fracture:
Root fracture:
LISTING
List the signs and symptoms of a skull fracture.
46.
47.

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Chapter 22 The Head, Face, Eyes, Ears, Nose, and Throat

48.
49.
50.

ESSAY
51-55.What is the procedure for removing a foreign body from the eye?

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