Head and Neck Trauma

Transcription

1 Head and Neck Trauma An Interdisciplinary Approach Bearbeitet von Rainer Ottis Seidl, Michael Herzog, Arneborg Ernst 1. Auflage Buch. 240 S. Hardcover ISBN Format (B x L): 19,5 x 27 cm Weitere Fachgebiete > Medizin > Chirurgie > Orthopädie- und Unfallchirurgie Zu Leseprobe schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, ebooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte.

2 I Evaluation of Head and Neck Trauma 1 Initial Management... 2 First Aid at the Scene... 2 Evaluation of Vital Functions... 2 Stabilizing Vital Functions... 2 Stabilizing Circulation... 2 Emergency Care... 2 Emergency Measures... 3 Airways... 3 Fall-Back of the Tongue... 3 Injuries of the Larynx and Trachea... 4 Hemorrhage... 6 Central Hemorrhage... 6 Peripheral Hemorrhage... 9 Priorities in Trauma Management Examining the Patient Patient History Inspection Functional Testing...12 Radiologic Diagnostics Palpation Flow Charts and Checklists Initial Management Initial Evaluation Injuries of the Neurocranium Injuries of the Skull Base Craniofacial Injuries...20 Injuries of the Orbits...22 Dental Injury...24 Injuries of the Neck...25 Injures of the Ear and Lateral Skull Base Injuries of the Facial Nerve General Principles of Trauma...27 Cutaneous Wounds...27 Pathomechanism and Classification...27 Wounds Caused by Mechanical Forces...27 Thermal and Chemical Wounds...29 Skin Healing...30 Osseous Injuries...31 Pathomechanism and Classification...31 Fracture Signs...31 Bone Healing...31 Direct (Primary) Fracture Healing...32 Indirect (Secondary) Fracture Healing...33 Pseudarthrosis...33 Fracture Treatment...33 Reduction...33 Fixation...33 Retention...33 Immobilization...33 Rehabilitation and Functional Therapy...34 Injuries of the Joints...34 Pathomechanism and Classification...34 Cartilage Injury...34 Pathomechanism and Classification...34 Cartilage Healing...34 VII

3 Muscular Injury...34 Clinical Signs and Symptoms...34 Muscular Healing...34 Peripheral Nerve Injury...35 Pathomechanism and Classification...35 Neural Healing...35 II Diagnostic of Head and Neck Trauma 5 Injuries of the Neurocranium and Craniocervical Junction...38 Injuries of the Neurocranium...38 Open and Closed Head Injury...38 Clinical Signs and Symptoms...38 Diagnostic Imaging...39 Treatment...39 Injury to Bony Structures of the Craniocervical Junction...40 Anatomy and Pathomechanism...40 Clinical Signs and Symptoms...40 Classification...40 Diagnostic Imaging...42 Soft Tissue Distortion and Discoligamentous Injuries of the Craniocervical Junction...42 Pathomechanism...42 Clinical Signs and Symptoms...42 Classification...42 Clinical and Neurological Diagnosis...42 Imaging Modalities Diagnosing Injuries of the Skull Base...45 Surgical Anatomy...45 Anterior Cranial Fossa...46 Middle Cranial Fossa...46 Posterior Cranial Fossa...46 Pathomechanism and Classification...46 Pathomechanism...46 Dural Injury...47 Classification of Fractures...47 Clinical Signs and Symptoms...48 Uncertain Signs of Fracture of the Anterior Skull Base...48 Eyelid Hematoma, Eyelid Emphysema...48 Epistaxis...49 Seiferth Sign...49 Olfactory Disturbances...49 Certain Signs of Fracture of the Anterior Skull Base...50 Cerebrospinal Fluid Rhinorrhea...50 Evaluation of Suspected Cerebrospinal Fluid Rhinorrhea...50 Pneumocephalus Early Meningitis Diagnostic Imaging of Fractures of the Anterior Skull Base Surgical Indications in Injuries of the Anterior Skull Base Diagnosing Injuries of the Ear and Lateral Skull Base...53 Surgical Anatomy...53 Pathomechanism and Classification...54 Injuries of the External Ear...54 Injuries of the Middle Ear...55 Injuries of the Tympanic Membrane...55 Ossicular Injuries...56 Rupture of the Round Window Membrane...57 Injuries of the Petrous Temporal Bone and Labyrinth...57 Concussion of the Petrous Temporal Bone and Bony Labyrinth...57 Fractures of the Petrous Temporal Bone and Bony Labyrinth...57 Fracture Line in Longitudinal Fractures...57 Fracture Line in Transverse Fractures...58 Clinical Signs and Symptoms...59 Aural Hemorrhage...59 Cerebrospinal Fluid Otorrhea...59 Hearing Dysfunction...60 Sensorineural Hearing Loss...60 Conductive Hearing Loss...60 Vestibular Disorder...60 Functional Testing of the Auditory and Vestibular System...61 Audiometry...61 Tuning Fork Tests...61 Pure Tone Audiometry...61 VIII

4 Vestibular Tests...61 Frenzel Lenses...61 Vestibulospinal Reflexes...62 Romberg Test...62 Unterberger Stepping Test...62 Caloric Testing...62 Diagnostic Imaging Diagnosing Injuries of the Facial Nerve...64 Surgical Anatomy...64 Intracranial Segment...64 Intratemporal Segment...64 Pathomechanism and Classification...66 Classification...66 House Brackmann Scale...66 Clinical Signs and Functional Tests...67 Topodiagnostic Evaluation...67 Tearing (Schirmer Test)...67 Taste...67 Measurement of Stapedial Reflex...67 Electrophysiologic Testing...67 Electromyography (EMG)...67 Management Diagnosing Injuries of the Midface...69 Surgical Anatomy...69 Classification of Midface Fractures...70 Central Fractures of the Midface...71 Fractures of the Alveolar Process...71 Pathomechanism...71 Le Fort I Fractures...71 Pathomechanism...71 Clinical Symptoms...71 Diagnostic Imaging...72 Treatment...73 Le Fort II Fractures, Wassmund I Fractures...73 Pathomechanism...73 Clinical Symptoms Diagnostic Imaging Treatment Le Fort III Fractures, Wassmund IV Fractures...75 Surgical Anatomy...75 Pathomechanism...75 Clinical Symptoms...76 Diagnostic Imaging...76 Treatment...76 Fractures of the Nasoethmoidal Complex...76 Surgical Anatomy...76 Pathomechanism...76 Classification...77 Clinical Symptoms...77 Diagnostic Imaging...79 Treatment...79 Fractures of the Bony Nasal Framework and Septum...79 Surgical Anatomy...79 Pathomechanism...79 Classification...80 Clinical Symptoms...80 Diagnostic Imaging...80 Treatment...81 Fractures of the Lateral Midface...82 Zygomatic Fracture...82 Surgical Anatomy...82 Pathomechanism...82 Classification...82 Clinical Signs...83 Zygomatic Arch Fracture...83 Pathomechanism...83 Clinical Signs...83 Diagnostic Imaging...85 Treatment Diagnosing Injuries of the Orbit...86 Surgical Anatomy...86 Orbital Wall Fractures...88 Fractures of the Orbital Floor and Medial Orbital Wall...88 Pathomechanism...88 Clinical Signs and Symptoms...88 Traction Test/Forward Traction Test...89 Endoscopy of the Maxillary Sinus...89 Diagnostic Imaging...89 Treatment...90 Fractures of the Orbital Roof and Lateral Orbital Wall...90 Pathomechanism...90 Clinical Signs and Symptoms...90 Diagnostic Imaging...90 Treatment...90 IX

5 Injuries of the Orbital Apex Pathomechanism and Classification Clinical Signs and Symptoms Injury of the Oculomotor Nerve Injury of the Trochlear Nerve Injury of the Abducens Nerve Injury of the Optic Nerve Injury of the Trigeminal Nerve Diagnostic Imaging Treatment Injuries of the Lacrimal Ducts Pathomechanism Clinical Signs and Symptoms Diagnostic Imaging Treatment Carotid-Cavernous Sinus Fistula Pathomechanism Clinical Signs and Symptoms Diagnostic Imaging Diagnosing Injuries of the Mandible Surgical Anatomy Pathomechanism Clinical Signs and Symptoms Certain Signs of Fracture Deformity and Dislocation Abnormal Mobility Crepitus Uncertain Fracture Signs Hematoma and Swelling Tenderness Longitudinal Compression Pain Restricted Function Sensory Disturbances Malocclusion Diagnostic Imaging Classification of Mandibular Fractures Fractures of the Mandibular Body with Dentoalveolar Involvement Pathomechanisms Diagnostic Imaging Treatment Mandibular Fractures without Dentoalveolar Involvement Clinical Signs and Symptoms Diagnostic Imaging Treatment Fractures of the Ramus of Mandible Pathomechanism Clinical Signs Diagnostic Imaging Treatment Injuries of the Condylar Process Contusion of the Temporomandibular Joint Distortion of the Temporomandibular Joint Dislocation of the Temporomandibular Joint Subluxation of the Temporomandibular Joint..106 Fracture of the Temporomandibular Joint Diagnosing Dental Injuries Surgical Anatomy Pathomechanism Dental Fractures Classification Clinical Diagnosis Diagnostic Imaging Treatment Dental Luxation Pathomechanism Classification Clinical Diagnosis Diagnostic Imaging Treatment Dental Concussion Pathomechanism Diagnostic Imaging Treatment Dental Luxation without Dislocation (Loosening, Subluxation) Pathomechanism Clinical Signs Diagnostic Imaging Treatment Dental Luxation with Dislocation Partial Peripheral Dislocation Complete Peripheral Dislocation Central Luxation Fractures of the Alveolar Process Pathomechanism Clinical Signs Diagnostic Imaging Treatment X

6 13 Diagnosing Injuries of the Pharynx, Salivary Glands, and Soft Tissues of the Neck Injuries of the Pharynx Injuries of the Salivary Glands Soft Tissue Injuries of the Neck Blunt Trauma to the Soft Tissues of the Neck Sharp Trauma of the Soft Tissues of the Neck Diagnosing Injuries of the Larynx and Trachea Surgical Anatomy Pathomechanism and Classification Fractures Anteroposteriorly Directed Trauma Lateral Trauma Supraglottic Injuries Transglottic Injuries Subglottic Injuries Tracheal Injuries Ruptures Supraglottic Rupture Subglottic Rupture Laryngotracheal Separation Partial Laryngotracheal Separation Complete Laryngotracheal Separation Esophageal Rupture Clinical Signs and Symptoms Respiratory Distress Emphysema Complications Evaluation Procedures and Functional Testing Endoscopy Magnifying Laryngoscopy and Flexible Nasopharyngolaryngoscopy Microlaryngoscopy, Tracheobronchoscopy Radiographic Evaluation Evaluation of Phonation Stroboscopy Vocal Output and Characteristics Electrodiagnostic Testing Treatment III Therapy of Head and Neck Trauma 15 Principles of Wound Management The Ten Commandments of Wound Management Abrasions Immediate Management/Treatment Puncture Wounds Immediate Management Treatment Cut Wounds Immediate Management Treatment Bite Wounds Immediate Management Treatment Missile Wounds Immediate Management Treatment Burn Injury Immediate Management Treatment Chemical/Alkali Burns Immediate Management Treatment Wound Closure Suture Technique Suture Material Wound Dressings Treatment of Injuries of the Neurocranium and Craniocervical Junction Treatment Principles for Craniocerebral Trauma.137 Treatment of Fractures of the Craniocervical Junction Atlantooccipital Fractures/Dislocations Treatment of Soft Tissue Distortion and Discoligamentous Injuries of the Craniocervical Junction..139 XI

7 17 Treatment of Injuries of the Skull Base Indications Approaches Ear-to-Ear Scalp Incision, Bicoronal Incision Frontoorbital Approach Endonasal Approach Surgical Technique Principles of Dural Repair Frontal Sinus Extradural Management Intradural Management Ethmoid Bone Sphenoid Sinus Grafts Autogenous Grafts Homologous Grafts Alloplastic Implants Postoperative Management Frontal Sinus Ethmoid/Sphenoid Sinus Drainage of Cerebrospinal Fluid Follow-up Care Complications Treatment of Injuries of the Ear and Lateral Skull Base Injuries of the External Ear Indications Surgical Methods Seroma and Hematomas of the Ear Injuries of the Auricle Auricular Amputation Injuries of the Vestibulocochlear System Indications Conservative Management Inner Ear Auditory Dysfunction Vestibular Disorder Surgical Management Approaches Surgical Techniques Injuries of the Facial Nerve Indications Conservative Treatment Surgical Management Follow-up Care Treatment of Injuries of the Midface Conservative Management Splinting Intraoral Splinting Extraoral Splinting Controlled Spontaneous Healing Monomaxillary Fixation Intermaxillary Fixation Intermaxillary Fixation and Stabilization with a Halo Frame Surgical Procedures Craniofacial Suspension Wiring Osteosynthesis with Miniplates and Microplates Osteosynthesis Techniques Osteosynthesis Materials Osteosynthesis Systems Principles of Reconstruction Infrazygomatic Fractures (Le Fort I) Indications Conservative Management Surgical Treatment Complications Central or Pyramidal Fractures (Le Fort II, Wassmund I) Indications Conservative Management Surgical Technique Complications Centrolateral Fractures (Le Fort III, Wassmund IV) Indications Conservative Management Surgical Technique Complications Fractures of the Nasoethmoidal Complex Indications Surgical Treatment Fractures of the Bony Nasal Skeleton and Septum Indications Approaches Surgical Technique XII

8 Fractures of the Lateral Midface Indications Approaches Surgical Technique Treatment of Orbital Injuries Fractures of the Orbital Floor Indications Approaches Surgical Technique Complications Medial Orbits Indications Approaches Surgical Technique Complications Orbital Roof Indications Approaches Surgical Technique Complications Orbital Decompression Indications Approaches Surgical Technique Complications Optic Nerve Decompression Indications Approaches Surgical Technique Complications Injuries of the Lacrimal Ducts Indications Surgical Technique Complications Injuries of the Eyelids Indications Surgical Technique Complications Treatment of Injuries of the Mandible Fractures of the Mandibular Body with Dentoalveolar Involvement Indications Conservative Management Surgical Management Approaches Surgical Technique Complications Fractures of the Mandible without Dentoalveolar Involvement or in the Partially Edentulous Jaw..190 Fractures of the Mandibular Ramus Conservative Treatment Surgical Treatment Approaches Surgical Technique Complications Fractures in the Edentulous, Atrophied Mandible 190 Mandibular Defect Fractures Contaminated Mandibular Fractures Fractures of the Mandible in Patients with Primary or Deciduous Teeth Nondisplaced Fractures of the Condylar Neck and Head Indications Conservative Treatment Surgical Treatment Approaches Intraoral Approach Approaches Extraoral Retromandibular (Submandibular) Approach Functional Treatment Displaced Fractures and Fracture-Dislocations of the Condylar Neck Indications Conservative Management Complications Surgical Management Approaches Surgical Technique Complications Fractures of the Condylar Head Conservative Management Surgical Treatment Approaches Surgical Technique Fractures of the Articular Fossa (Central Dislocation) Pediatric Fractures of the Condylar Neck and Condylar Head XIII

9 22 Treatment of Dental Injuries Treatment of Dental Injuries Indications Conservative Treatment of Crown Fractures Enamel Fractures Enamel-Dentin Fractures without Pulp Exposure Enamel-Dentin Fractures with Pulp Exposure. 199 Surgical Management of Root Fractures Coronal Third Root Fractures Middle Third Root Fractures Apical Third Root Fractures Longitudinal Fractures Approaches (Resection of the Root Tip) Surgical Technique Complications Treatment of Dental Luxation Indications Primary Teeth Surgical Treatment Dental Concussion Dental Luxation without Displacement (Tooth Loosening) Partial Peripheral Luxation Complete Peripheral Luxation Central Luxation Complications Treatment of Fractures of the Alveolar Process. 203 Indications Conservative Treatment Surgical Management Approaches Surgical Technique Complications Treatment of Injuries of the Larynx, Pharynx, Trachea, Esophagus, and Soft Tissues of the Neck Indications Conservative Treatment Chemical/Alkali Injuries Surgical Therapy Approaches Surgical Procedure Complications IV Appendix 24 Antibiotic Therapy Grafting and Osteosynthesis Materials Requirements and Classification Autogenic Grafts Outer Table of the Skull Allogenous (Homologous) Grafts Preserved Allografts Alloplastic Implants Absorbable Alloplastic Implants Polydioxanone (PDS) Ethisorb Vicryl Monocryl Nonabsorbable Alloplastic Implants Metal Further Reading Index XIV