Penetrierende Gesichts- und Halsverletzungen

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.

Urgent Intracranial Carotid Artery Decompression after Penetrating Head Injury

“…When HRCT is performed alongside CT angiography or perfusion CT, it is possible to assess vascular injuries at the same time4).…”

“…Reports of penetrating craniofacial injuries due to construction equipment are increasing around the world4). Such injuries are typically caused by metal or biological tissue fragments (bone, teeth).…”

Immunonutrition – the influence of early postoperative glutamine supplementation in enteral/parenteral nutrition on immune response, wound healing and length of hospital stay in multiple trauma patients and patients after extensive surgery

“…In the postoperative phase, the prognosis of multiple trauma patients after extensive surgery mainly depends on protein metabolism and the prevention of septic complications [ 1 ], [ 2 ]. Wound healing problems also result in markedly longer stays in the intensive care unit and general wards.…”

Trauma of the midface

“…Lesions of the soft tissue are mentioned only if they are important for the respective pattern of injury. Of course, it is very important to treat them appropriately because even in cases of perfectly reconstructed bony skeleton, scars may lead to deformities and dysfunctions that can only be corrected secondarily with significant difficulties [ 1 ], [ 2 ].…”