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Penetrierende Gesichts- und Halsverletzungen

Diagnostik und Therapie

Penetrating injuries in the face and neck region

Diagnosis and treatment

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Zusammenfassung

Penetrierende Gesichts- und Halsverletzungen sind infolge von Gefäßverletzungen und einer Atemwegsverlegung häufig lebensbedrohlich. Blutstillung und Sicherung der Atemwege stehen daher bei der Erstversorgung im Vordergrund. Verletzungen durch Hochrasanzgeschosse führen zu schweren Gewebszerstörungen mit Substanzverlusten und stellen hohe Anforderungen an die Kopf-Hals-Chirurgen. Da mehrere Organstrukturen, wie Augen, Gesichtsschädel, Pharynx, Larynx, Trachea, Ösophagus, Hirnnerven, Gefäße und Wirbelsäule, gleichzeitig betroffen sein können, ist nach der Akutversorgung eine interdisziplinäre Behandlung in einem spezialisierten Traumazentrum anzustreben. Verletzungen durch Hochrasanzgeschosse traten bis vor wenigen Jahren überwiegend bei kriegerischen Auseinandersetzungen auf und waren in Europa nach dem 2. Weltkrieg selten. Daher verfügen die meisten Kopf-Hals-Chirurgen nur über begrenzte Erfahrungen damit. Mit der Zunahme terroristischer Anschläge, bei denen bevorzugt selbstgebaute Sprengsätze zum Einsatz kommen, werden grundlegende Kenntnisse über die akute und definitive Versorgung von betroffenen Opfern auch für zivile Kopf-Hals-Chirurgen relevant. In der vorliegenden Übersichtsarbeit werden aktuelle Gesichtspunkte für die Diagnostik und Therapie von penetrierenden Gesichts- und Halsverletzungen dargestellt.

Abstract

Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

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Maier, H., Tisch, M., Lorenz, K. et al. Penetrierende Gesichts- und Halsverletzungen. HNO 59, 765–782 (2011). https://doi.org/10.1007/s00106-011-2349-1

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