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Laryngorhinootologie 2015; 94(S 01): S206-S247
DOI: 10.1055/s-0034-1396873
Referat
© Georg Thieme Verlag KG Stuttgart · New York

Traumatologie des Mittelgesichts

Trauma of the Midface
T. S. Kühnel
1   HNO-Universitätsklinik und Poliklinik Regensburg
,
T. E. Reichert
2   Klinik und Poliklinik für Mund-, Kiefer-und Gesichtschirurgie Universitätsklinik Regensburg
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
10. April 2015 (online)

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Zusammenfassung

Mittelgesichtsfrakturen sind in den Industrieländern wegen ihrer Häufigkeit, Komplexität und sozioökonomischen Bedeutung ein ernst zu nehmendes medizinisches Problem. Die interdisziplinäre Zuwendung der verschiedenen Fachdisziplinen ermöglicht dank moderner Schnittbilddiagnostik und filigraner Osteosyntheseverfahren eine Versorgung mit funktionell und ästhetisch günstigen Ergebnissen. Verkehrsunfälle führen die Liste der Ursachen an, wobei zahlenmäßig Männer in der dritten Lebensdekade am stärksten betroffen sind. Neben Verletzungen der Nasenbeine, des Oberkiefers und der Jochbeine, für die sich Versorgungsalgorithmen mit breitem Konsens durchgesetzt haben, sind die Verletzungen der Stirnhöhle und der Orbitaspitze, insbesondere des N. opticus Gegenstand einer andauernden Kontroverse um die beste Therapieform. Die Fortschritte der endoskopischen Chirurgie und die Grenzen des evidenzbasierten Erkenntnisgewinns spielen in dieser Diskussion eine besondere Rolle und werden in den entsprechenden Abschnitten beleuchtet. Für die Stirnhöhlenfrakturen zeichnet sich ein Wandel von großen Zugängen zu gering invasiven Techniken ab. In der Therapie der traumatischen Optikusneuropathie sind kritische Anmerkungen zur hoch dosierten Kortisongabe angebracht. Neue Materialien wie präformierte Titangitter und die intraoperative Bildgebung sind wesentliche Aspekte in der aktuellen Traumatologie der Orbita. Für die Versorgung frontobasaler Frakturen mit Liquorrhoe haben sich die endoskopischen Verschlusstechniken ihrer geringen Morbidität und großen Sicherheit wegen durchgesetzt und haben neben den neurochirurgischen Verfahren einen bedeutenden Stellenwert erlangt.

Abstract

Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often.

Treatment algorithms for nasal bone fractures, maxillary and zygoma fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter.

As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialisation seem to decrease in numbers.

Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate.

Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology.

Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.

Schlüsselwörter

Rhinologie - Traumatologie - Mittelgesicht - Orbita - endoskopische Nasennebenhöhlenchirurgie

Key words

rhinology - trauma - midface fractures - orbit - ESS
 

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