Alterstraumatologie im Gesichtsschädelbereich

Zusammenfassung

CMF-Traumen im Alter 65+ sind durch besondere Merkmale gekennzeichnet: Lokalisation und Frakturmuster, Stand des Involutionsprozesses mit Abnahme von Knochenquantität und -qualität, Begleitverletzungen, altersassoziierte physische und psychische Funktionseinbußen und präexistente Komorbiditäten. Der Stand des Wissens und aktuelle bevölkerungsbezogene Daten dieser Variablen werden zu Anfang dieser Übersicht dargestellt. Vor diesem Hintergrund wird dann zu den verschiedenen Frakturen und Frakturtypen in den einzelnen Regionen des Gesichtsschädelskeletts Stellung genommen und die Indikation zu einem konservativen oder operativen Prozedere in den Alterspopulationen diskutiert. Spezielle Aufmerksamkeit kommt dabei Fraktursituationen bei Zahnlosigkeit und Atrophie im Ober- und/oder Unterkiefer zu. Innerhalb des weitgesteckten Gesamtspektrums der Frakturszenarien haben schonende, situationsadaptierte, ggf. auch unkonventinelle Lösungen Priorität vor Standardtherapieverfahren. Neue Techniken wie computerassistierte Chirurgie und patientenspezifische Implantate spielen eine immer größere Rolle und werden an Einzelbeispielen demonstriert. Betont werden muss, dass die physischen Reserven und nötigenfalls die geriatrietypische Multimorbidität jedes Patienten individuell einzuschätzen ist und vorrangige Bedeutung vor dem kalendarischen Lebensalter hat.

Abstract

Craniomaxillofacial trauma at advanced age (65+) is characterized by particular features: fracture location and pattern, state of the involution process in terms of bone mass and quality, concomitant injuries, age associated functional deficits and preexisting comorbidities. The available knowledge and the current population-based data of these variables are outlined at the beginning of this review. This provides the background information to consider the varying fracture and fracture types in the specific regions of the facial skeleton in order to discuss the differential indications for conservative or operative treatment in the elderly aging stages. Special attention is given to fracture conditions in the edentulous atrophic maxilla and/or mandible. Within the abundant diversity of fracture scenarios delicate treatment solutions, adapted to the medical condition and unconventional, where applicable, are prioritized over standardized therapeutic procedures. New techniques such as computer assisted surgery and patient-specific implants play a growing role and will be exemplified in selected case reports. Finally it cannot be overemphasized that the physical capacities up to geriatric multimorbidity of a patient are of primary importance above the calender age.

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