Head and Neck Trauma An Interdisciplinary Approach Bearbeitet von Rainer Ottis Seidl, Michael Herzog, Arneborg Ernst 1. Auflage 2006. Buch. 240 S. Hardcover ISBN 978 3 13 140001 7 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.
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... 10 2 Examining the Patient... 11 Patient History... 11 Inspection... 11 Functional Testing...12 Radiologic Diagnostics... 13 Palpation... 11 3 Flow Charts and Checklists... 15 Initial Management... 15 Initial Evaluation... 15 Injuries of the Neurocranium... 16 Injuries of the Skull Base... 17 Craniofacial Injuries...20 Injuries of the Orbits...22 Dental Injury...24 Injuries of the Neck...25 Injures of the Ear and Lateral Skull Base... 18 Injuries of the Facial Nerve... 19 4 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
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...44 6 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... 51 Early Meningitis... 51 Diagnostic Imaging of Fractures of the Anterior Skull Base... 51 Surgical Indications in Injuries of the Anterior Skull Base...52 7 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
Vestibular Tests...61 Frenzel Lenses...61 Vestibulospinal Reflexes...62 Romberg Test...62 Unterberger Stepping Test...62 Caloric Testing...62 Diagnostic Imaging...62 8 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...68 9 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... 74 Diagnostic Imaging... 74 Treatment... 74 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...85 10 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
Injuries of the Orbital Apex... 90 Pathomechanism and Classification... 90 Clinical Signs and Symptoms... 91 Injury of the Oculomotor Nerve... 91 Injury of the Trochlear Nerve... 91 Injury of the Abducens Nerve... 91 Injury of the Optic Nerve... 91 Injury of the Trigeminal Nerve... 93 Diagnostic Imaging... 93 Treatment... 94 Injuries of the Lacrimal Ducts... 94 Pathomechanism... 94 Clinical Signs and Symptoms... 94 Diagnostic Imaging... 94 Treatment... 94 Carotid-Cavernous Sinus Fistula... 94 Pathomechanism... 94 Clinical Signs and Symptoms... 94 Diagnostic Imaging... 95 11 Diagnosing Injuries of the Mandible... 96 Surgical Anatomy... 96 Pathomechanism... 97 Clinical Signs and Symptoms... 97 Certain Signs of Fracture... 98 Deformity and Dislocation... 98 Abnormal Mobility... 98 Crepitus... 98 Uncertain Fracture Signs... 98 Hematoma and Swelling... 98 Tenderness... 98 Longitudinal Compression Pain... 99 Restricted Function... 99 Sensory Disturbances... 99 Malocclusion... 99 Diagnostic Imaging... 99 Classification of Mandibular Fractures...100 Fractures of the Mandibular Body with Dentoalveolar Involvement...100 Pathomechanisms...100 Diagnostic Imaging...101 Treatment...101 Mandibular Fractures without Dentoalveolar Involvement...102 Clinical Signs and Symptoms...104 Diagnostic Imaging...104 Treatment...104 Fractures of the Ramus of Mandible...104 Pathomechanism...104 Clinical Signs...105 Diagnostic Imaging...105 Treatment...105 Injuries of the Condylar Process...105 Contusion of the Temporomandibular Joint...105 Distortion of the Temporomandibular Joint...106 Dislocation of the Temporomandibular Joint...106 Subluxation of the Temporomandibular Joint..106 Fracture of the Temporomandibular Joint...108 12 Diagnosing Dental Injuries... 112 Surgical Anatomy...112 Pathomechanism...112 Dental Fractures...112 Classification...112 Clinical Diagnosis...112 Diagnostic Imaging... 113 Treatment... 113 Dental Luxation... 113 Pathomechanism... 113 Classification... 113 Clinical Diagnosis... 114 Diagnostic Imaging... 114 Treatment... 114 Dental Concussion... 114 Pathomechanism... 114 Diagnostic Imaging... 114 Treatment... 114 Dental Luxation without Dislocation (Loosening, Subluxation)... 114 Pathomechanism... 114 Clinical Signs... 114 Diagnostic Imaging... 114 Treatment... 115 Dental Luxation with Dislocation... 115 Partial Peripheral Dislocation... 115 Complete Peripheral Dislocation... 116 Central Luxation... 117 Fractures of the Alveolar Process... 118 Pathomechanism... 118 Clinical Signs... 118 Diagnostic Imaging... 119 Treatment... 119 X
13 Diagnosing Injuries of the Pharynx, Salivary Glands, and Soft Tissues of the Neck...120 Injuries of the Pharynx...120 Injuries of the Salivary Glands...120 Soft Tissue Injuries of the Neck...120 Blunt Trauma to the Soft Tissues of the Neck...120 Sharp Trauma of the Soft Tissues of the Neck...120 14 Diagnosing Injuries of the Larynx and Trachea...121 Surgical Anatomy...121 Pathomechanism and Classification...122 Fractures...124 Anteroposteriorly Directed Trauma...124 Lateral Trauma...124 Supraglottic Injuries...124 Transglottic Injuries...124 Subglottic Injuries...125 Tracheal Injuries...125 Ruptures...125 Supraglottic Rupture...125 Subglottic Rupture...125 Laryngotracheal Separation...125 Partial Laryngotracheal Separation...125 Complete Laryngotracheal Separation...125 Esophageal Rupture...125 Clinical Signs and Symptoms...126 Respiratory Distress...126 Emphysema...126 Complications...126 Evaluation Procedures and Functional Testing...127 Endoscopy...127 Magnifying Laryngoscopy and Flexible Nasopharyngolaryngoscopy...127 Microlaryngoscopy, Tracheobronchoscopy...127 Radiographic Evaluation...127 Evaluation of Phonation...127 Stroboscopy...127 Vocal Output and Characteristics...127 Electrodiagnostic Testing...127 Treatment...128 III Therapy of Head and Neck Trauma 15 Principles of Wound Management...130 The Ten Commandments of Wound Management...130 Abrasions...130 Immediate Management/Treatment...130 Puncture Wounds...131 Immediate Management...131 Treatment...131 Cut Wounds...131 Immediate Management...131 Treatment...131 Bite Wounds...131 Immediate Management...131 Treatment...131 Missile Wounds...133 Immediate Management...133 Treatment...133 Burn Injury...133 Immediate Management...133 Treatment...134 Chemical/Alkali Burns...134 Immediate Management...134 Treatment...134 Wound Closure...135 Suture Technique...135 Suture Material...135 Wound Dressings...136 16 Treatment of Injuries of the Neurocranium and Craniocervical Junction...137 Treatment Principles for Craniocerebral Trauma.137 Treatment of Fractures of the Craniocervical Junction...138 Atlantooccipital Fractures/Dislocations...138 Treatment of Soft Tissue Distortion and Discoligamentous Injuries of the Craniocervical Junction..139 XI
17 Treatment of Injuries of the Skull Base...140 Indications...140 Approaches...140 Ear-to-Ear Scalp Incision, Bicoronal Incision...140 Frontoorbital Approach...141 Endonasal Approach...141 Surgical Technique...142 Principles of Dural Repair...142 Frontal Sinus...143 Extradural Management...143 Intradural Management...143 Ethmoid Bone...143 Sphenoid Sinus...144 Grafts...144 Autogenous Grafts...144 Homologous Grafts...145 Alloplastic Implants...145 Postoperative Management...145 Frontal Sinus...145 Ethmoid/Sphenoid Sinus...145 Drainage of Cerebrospinal Fluid...145 Follow-up Care...145 Complications...146 18 Treatment of Injuries of the Ear and Lateral Skull Base...147 Injuries of the External Ear...147 Indications...147 Surgical Methods...147 Seroma and Hematomas of the Ear...147 Injuries of the Auricle...148 Auricular Amputation...148 Injuries of the Vestibulocochlear System...149 Indications...149 Conservative Management...149 Inner Ear Auditory Dysfunction...149 Vestibular Disorder...150 Surgical Management...150 Approaches...150 Surgical Techniques...151 Injuries of the Facial Nerve...153 Indications...153 Conservative Treatment...154 Surgical Management...154 Follow-up Care...156 19 Treatment of Injuries of the Midface...157 Conservative Management...157 Splinting...157 Intraoral Splinting...157 Extraoral Splinting...158 Controlled Spontaneous Healing...159 Monomaxillary Fixation...159 Intermaxillary Fixation...159 Intermaxillary Fixation and Stabilization with a Halo Frame...159 Surgical Procedures...160 Craniofacial Suspension Wiring...160 Osteosynthesis with Miniplates and Microplates...160 Osteosynthesis Techniques...161 Osteosynthesis Materials...162 Osteosynthesis Systems...167 Principles of Reconstruction...167 Infrazygomatic Fractures (Le Fort I)...170 Indications...170 Conservative Management...170 Surgical Treatment...170 Complications...171 Central or Pyramidal Fractures (Le Fort II, Wassmund I)...172 Indications...172 Conservative Management...172 Surgical Technique...172 Complications...172 Centrolateral Fractures (Le Fort III, Wassmund IV)...173 Indications...173 Conservative Management...173 Surgical Technique...173 Complications... 174 Fractures of the Nasoethmoidal Complex... 174 Indications... 174 Surgical Treatment... 174 Fractures of the Bony Nasal Skeleton and Septum...176 Indications...176 Approaches...176 Surgical Technique...176 XII
Fractures of the Lateral Midface...177 Indications...177 Approaches...177 Surgical Technique...178 20 Treatment of Orbital Injuries...179 Fractures of the Orbital Floor...179 Indications...179 Approaches...179 Surgical Technique...179 Complications...179 Medial Orbits...182 Indications...182 Approaches...182 Surgical Technique...182 Complications...182 Orbital Roof...182 Indications...182 Approaches...182 Surgical Technique...182 Complications...183 Orbital Decompression...183 Indications...183 Approaches...183 Surgical Technique...183 Complications...183 Optic Nerve Decompression...184 Indications...184 Approaches...184 Surgical Technique...184 Complications...184 Injuries of the Lacrimal Ducts...184 Indications...184 Surgical Technique...184 Complications...184 Injuries of the Eyelids...185 Indications...185 Surgical Technique...185 Complications...185 21 Treatment of Injuries of the Mandible...186 Fractures of the Mandibular Body with Dentoalveolar Involvement...186 Indications...186 Conservative Management...186 Surgical Management...186 Approaches...186 Surgical Technique...186 Complications...189 Fractures of the Mandible without Dentoalveolar Involvement or in the Partially Edentulous Jaw..190 Fractures of the Mandibular Ramus...190 Conservative Treatment...190 Surgical Treatment...190 Approaches...190 Surgical Technique...190 Complications...190 Fractures in the Edentulous, Atrophied Mandible 190 Mandibular Defect Fractures...191 Contaminated Mandibular Fractures...191 Fractures of the Mandible in Patients with Primary or Deciduous Teeth...192 Nondisplaced Fractures of the Condylar Neck and Head...193 Indications...193 Conservative Treatment...193 Surgical Treatment...193 Approaches Intraoral Approach...194 Approaches Extraoral Retromandibular (Submandibular) Approach...194 Functional Treatment...196 Displaced Fractures and Fracture-Dislocations of the Condylar Neck...196 Indications...196 Conservative Management...196 Complications...196 Surgical Management...197 Approaches...197 Surgical Technique...197 Complications...197 Fractures of the Condylar Head...197 Conservative Management...197 Surgical Treatment...197 Approaches...197 Surgical Technique...197 Fractures of the Articular Fossa (Central Dislocation)...198 Pediatric Fractures of the Condylar Neck and Condylar Head...198 XIII
22 Treatment of Dental Injuries... 199 Treatment of Dental Injuries... 199 Indications... 199 Conservative Treatment of Crown Fractures... 199 Enamel Fractures... 199 Enamel-Dentin Fractures without Pulp Exposure... 199 Enamel-Dentin Fractures with Pulp Exposure. 199 Surgical Management of Root Fractures... 199 Coronal Third Root Fractures... 199 Middle Third Root Fractures... 200 Apical Third Root Fractures... 200 Longitudinal Fractures... 200 Approaches (Resection of the Root Tip)... 200 Surgical Technique... 200 Complications... 201 Treatment of Dental Luxation... 201 Indications... 201 Primary Teeth... 201 Surgical Treatment... 201 Dental Concussion... 201 Dental Luxation without Displacement (Tooth Loosening)... 202 Partial Peripheral Luxation... 202 Complete Peripheral Luxation... 202 Central Luxation... 203 Complications... 203 Treatment of Fractures of the Alveolar Process. 203 Indications... 203 Conservative Treatment... 203 Surgical Management... 203 Approaches... 203 Surgical Technique... 204 Complications... 204 23 Treatment of Injuries of the Larynx, Pharynx, Trachea, Esophagus, and Soft Tissues of the Neck... 205 Indications... 205 Conservative Treatment... 206 Chemical/Alkali Injuries... 206 Surgical Therapy... 206 Approaches... 206 Surgical Procedure... 206 Complications... 208 IV Appendix 24 Antibiotic Therapy... 210 25 Grafting and Osteosynthesis Materials... 211 Requirements and Classification... 211 Autogenic Grafts... 211 Outer Table of the Skull... 211 Allogenous (Homologous) Grafts... 212 Preserved Allografts... 212 Alloplastic Implants... 212 Absorbable Alloplastic Implants... 212 Polydioxanone (PDS)... 212 Ethisorb... 212 Vicryl... 212 Monocryl... 212 Nonabsorbable Alloplastic Implants... 212 Metal... 212 Further Reading... 214 Index... 215 XIV