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Rekonstruktionsmöglichkeiten nach Verletzungen der Kopf-Hals-Region

Options for reconstruction after injuries in the head and neck region

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Zusammenfassung

Rekonstruktionen nach Verletzungen im Kopf-Hals-Bereich müssen nicht nur funktionellen, sondern auch ästhetischen Kriterien genügen, da bei der exponierten anatomischen Lage dieser Region eine soziale Stigmatisierung leicht die Folge einer Verletzung sein kann. Störungen der Symmetrie wie z. B. durch eine Schiefnase, einen Enophthalmus oder eine (Teil‑)Amputation der Ohrmuschel nimmt auch ein Laie unmittelbar wahr. Auf der anderen Seite stellen z. B. Einschränkungen der Nasenatmung und des Riechvermögens oder Doppelbilder deutliche Minderungen der Lebensqualität der Betroffenen dar. Für rekonstruktive Maßnahmen ergeben sich daraus hohe Anforderungen, beiden genannten Aspekten gerecht zu werden. Im Rahmen dieser Übersicht werden Verletzungen der äußeren Nase, des lateralen Mittelgesichts inkl. des Orbitabodens sowie der Ohrmuschel erörtert.

Abstract

Reconstruction of lesions in the head and neck region must be both functionally and esthetically adequate, as the exposed anatomic position can easily lead to social stigmatization after injury. Distortion of symmetry, e.g., by a crooked nose, enophthalmos, or a (partial) amputation of the outer ear, is easily visible. On the other hand, limitations to nasal breathing and olfaction or diplopia may significantly reduce quality of life, and restoration of form and function continues to be challenging. This review discusses the treatment options for trauma of the external nose and the lateral midface, including the orbital floor and the auricle.

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Literatur

  1. Ahmed A, Imani P, Vuyk HD (2010) Reconstruction of significant saddle nose deformity using autogenous costal cartilage graft with incorporated mirror image spreader grafts. Laryngoscope 120:491–494

    Article  Google Scholar 

  2. Akdag O, Guray Evin S, Isik C et al (2019) Endoscopic-assisted zygomatic arch fracture repair with a preauricular approach. Plast Surg (Oakv) 27:107–111

    Article  Google Scholar 

  3. Andrade M, Fernandes VS, Boleo-Tome JP (1999) Saddle nose: our approach to the problem. Aesthetic Plast Surg 23:403–406

    Article  CAS  Google Scholar 

  4. Antia NH, Buch VI (1967) Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg 39:472–477

    Article  CAS  Google Scholar 

  5. Armin BB, Ruder RO, Azizadeh B (2011) Partial auricular reconstruction. Semin Plast Surg 25:249–256

    Article  Google Scholar 

  6. Avelar J (1986) Importance of ear reconstruction for the aesthetic balance of the facial contour. Aesthetic Plast Surg 10:147–156

    Article  CAS  Google Scholar 

  7. Bennett HS, Reilly PG (2011) Restylane—a temporary alternative for saddle nose deformity in nasal Wegener’s granulomatosis—how we do it. Br J Oral Maxillofac Surg 49:e3–5

    Article  Google Scholar 

  8. Bergeron JM, Raggio BS (2022) Zygomatic arch fracture. StatPearls, Treasure Island (FL)

    Google Scholar 

  9. Berghaus A, Stelter K, Naumann A et al (2010) Ear reconstruction with porous polyethylene implants. Adv Otorhinolaryngol 68:53–64

    Google Scholar 

  10. Boccieri A (2013) The crooked nose. Acta Otorhinolaryngol Ital 33:163–168

    CAS  Google Scholar 

  11. Brent B, Byrd HS (1983) Secondary ear reconstruction with cartilage grafts covered by axial, random, and free flaps of temporoparietal fascia. Plast Reconstr Surg 72:141–152

    Article  CAS  Google Scholar 

  12. Bulut OC, Wallner F, Oladokun D et al (2018) Long-term quality of life changes after primary septorhinoplasty. Qual Life Res 27:987–991

    Article  Google Scholar 

  13. Cakmak O, Emre IE, Ozkurt FE (2015) Identifying septal support reconstructions for saddle nose deformity: the Cakmak algorithm. JAMA Facial Plast Surg 17:433–439

    Article  Google Scholar 

  14. Cevizci R, Ustun Bezgin S, Cakir BO et al (2017) Dorsal augmentation of saddle nose deformity with toothpick-shaped costal cartilage grafts in the secondary septorhinoplasty. J Craniofac Surg 28:2063–2065

    Article  Google Scholar 

  15. Costan VV, Nicolau A, Sulea D et al (2021) The impact of 3D technology in optimizing midface fracture treatment-focus on the zygomatic bone. J Oral Maxillofac Surg 79:880–891

    Article  Google Scholar 

  16. Daniel RK, Brenner KA (2006) Saddle nose deformity: a new classification and treatment. Facial Plast Surg Clin North Am 14:301–312

    Article  Google Scholar 

  17. Dasdar S, Kianfar N, Sadeghi M et al (2021) The impact of facial asymmetry on the surgical outcome of crooked nose: a case control study. Aesthet Surg J 41:NP284–NP294

    Article  Google Scholar 

  18. East C (2021) Preservation rhinoplasty and the crooked nose. Facial Plast Surg Clin North Am 29:123–130

    Article  Google Scholar 

  19. Eren F, Oksuz S, Melikoglu C et al (2014) Saddle-nose deformity repair with microplate-adapted costal cartilage. Aesthetic Plast Surg 38:733–741

    Article  Google Scholar 

  20. Ferreira MG, Santos M (2022) Preservation rhinoplasty in the saddle nose: the reverse spare roof technique. Facial Plast Surg Aesthet Med 24(3):168–170. https://doi.org/10.1089/fpsam.2022.0036

    Article  Google Scholar 

  21. Gass M, Fussinger MA, Metzger MC et al (2022) Virtual reconstruction of orbital floor defects using a statistical shape model. J Anat 240:323–329

    Article  Google Scholar 

  22. Ghiasi S (2013) Reconstruction of saddle nose deformity with calvarial bone graft. J Pak Med Assoc 63:483–485

    Google Scholar 

  23. Gokler O, Kocak I (2021) The combined use of spreader flap and asymmetric spreader graft in crooked nose. Aesthetic Plast Surg 46(3):1332–1338. https://doi.org/10.1007/s00266-020-02061-x

    Article  Google Scholar 

  24. Goljanian Tabrizi A, Ghazizadeh M, Barati B et al (2020) Comparison of double lateral osteotomy and asymmetric dorsal hump reduction in correction of crooked nose. World J Plast Surg 9:290–295

    Article  Google Scholar 

  25. Gubisch W (2005) Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg 7:218–226

    Article  Google Scholar 

  26. Gumieiro EH, Dib LL, Jahn RS et al (2009) Bone-anchored titanium implants for auricular rehabilitation: case report and review of literature. Sao Paulo Med J 127:160–165

    Article  Google Scholar 

  27. Haug M, Schoeller T, Wechselberger G et al (2001) External ear injuries—classification and therapeutic concept. Unfallchirurg 104:1068–1075

    Article  CAS  Google Scholar 

  28. Hindin DI, Muetterties CE, Mehta C et al (2017) Treatment of isolated zygomatic arch fracture: improved outcomes with external splinting. Plast Reconstr Surg 139:1162e–1171e

    Article  CAS  Google Scholar 

  29. Irmak F, Yazar SK, Sirvan SS et al (2018) Use of roof-shaped costochondral cartilage for correction of saddle nose deformity. Plast Reconstr Surg 142:45–52

    Article  CAS  Google Scholar 

  30. Kalogjera L, Bedekovic V, Baudoin T et al (2003) Modified alar swing procedure in saddle nose correction. Aesthetic Plast Surg 27:209–212

    Article  Google Scholar 

  31. Kerdoud O, Aloua R, Kaouani A et al (2021) Repair of the orbital floor fractures: the endoscopic trans-maxillary approach as minimally invasive approach: a case-report. Int J Surg Case Rep 85:106279

    Article  Google Scholar 

  32. Kim JG, Rhee SC, Cho PD et al (2012) Absorbable plate as a perpendicular strut for acute saddle nose deformities. Arch Plast Surg 39:113–117

    Article  Google Scholar 

  33. Kim K, Kim J, Kim J et al (2022) A new technique of open septal reduction using polydioxanone plates for nasoseptal fracture: three-dimensional volumetric analysis. J Craniofac Surg 33:e156–e161

    Article  Google Scholar 

  34. Kocak I, Gokler O, Senturk E (2018) Is osteoplasty with unilateral osteotomy effective in the correction of the crooked nose? J Craniofac Surg 29:491–494

    Article  Google Scholar 

  35. Kocak I, Senturk E (2017) Osteoplasty in crooked nose deformity: a novel approach. Aesthetic Plast Surg 41:628–636

    Article  Google Scholar 

  36. Kridel RW, Sturm AK (2017) Dorsal augmentation with homologous rib. Facial Plast Surg 33:195–201

    Article  CAS  Google Scholar 

  37. Kuhnel T (2020) The maxillary sinus via a prelacrimal approach as a gateway to the retromaxillary space and orbital floor. HNO 68:590–597

    Google Scholar 

  38. Kuhnel T, Jagle H, Hosemann W et al (2017) Orbital floor fracture repair: the endonasal approach. Rhinology 55:348–354

    Article  CAS  Google Scholar 

  39. Kurbonov U, Davlatov A, Janobilova S et al (2018) The use of temporoparietal fascia flap for surgical treatment of traumatic auricle defects. Plast Reconstr Surg Glob Open 6:e1741

    Article  Google Scholar 

  40. Lavasani L, Leventhal D, Constantinides M et al (2010) Management of acute soft tissue injury to the auricle. Facial Plast Surg 26:445–450

    Article  CAS  Google Scholar 

  41. Ling XF, Yew CC, Mohd Nazri SB et al (2021) Unilateral zygomatic complex fracture—a comparison between nonsurgical treatment and surgical treatment. J Craniofac Surg 32:e627–e630

    Article  Google Scholar 

  42. Lo S, Kenway B, Hosni A (2011) Acellular porcine dermal collagen implant in saddle nose deformity. Plast Reconstr Surg 128:82e–84e

    Article  CAS  Google Scholar 

  43. Louis PJ, Aponte-Wesson RA, Fernandes RP et al (2013) Autogenous and prosthetic reconstruction of the ear. Oral Maxillofac Surg Clin North Am 25:271–286

    Article  Google Scholar 

  44. Luo X, Yang J, Yang Q et al (2012) Classification and reconstruction of posttraumatic ear deformity. J Craniofac Surg 23:654–657

    Article  Google Scholar 

  45. Ma Y, Lloyd MS (2022) Systematic review of medpor versus autologous ear reconstruction. J Craniofac Surg 33:602–606

    Article  Google Scholar 

  46. Musgrave RH, Garrett WS Jr. (1967) Management of avulsion injuries of the external ear. Plast Reconstr Surg 40:534–539

    Article  CAS  Google Scholar 

  47. Nagata S (1995) Total auricular reconstruction with a three-dimensional costal cartilage framework. Ann Chir Plast Esthet 40:371–399 (discussion 400–373)

    CAS  Google Scholar 

  48. Newberry CI, Mobley S (2018) Correction of the crooked nose. Facial Plast Surg 34:488–496

    Article  CAS  Google Scholar 

  49. Nojoumi A, Woo BM (2021) Management of ear trauma. Oral Maxillofac Surg Clin North Am 33:305–315

    Article  Google Scholar 

  50. Ozturan O, Aksoy F, Veyseller B et al (2013) Severe saddle nose: choices for augmentation and application of accordion technique against warping. Aesthetic Plast Surg 37:106–116

    Article  Google Scholar 

  51. Park IH, Lee HM, Yanagi K (2015) Endoscopic transantral and transnasal repair of orbital floor fracture with the ballooning technique, and classification and characterization of orbital floor fractures. Am J Rhinol Allergy 29:445–448

    Article  Google Scholar 

  52. Park J, Huh J, Lee J et al (2017) Reconstruction of large orbital posterior floor wall fracture considering orbital floor slope using endoscope. J Craniofac Surg 28:947–950

    Article  Google Scholar 

  53. Park SS, Hood RJ (2001) Auricular reconstruction. Otolaryngol Clin North Am 34:713–738

    Article  CAS  Google Scholar 

  54. Pickrell BB, Hughes CD, Maricevich RS (2017) Partial ear defects. Semin Plast Surg 31:134–140

    Article  Google Scholar 

  55. Rana M, Warraich R, Tahir S et al (2012) Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation—a randomised prospective clinical trial. Trials 13:36

    Article  Google Scholar 

  56. Razmpa E, Saedi B, Mahbobi F (2012) Augmentation rhinoplasty with combined use of medpor graft and irradiated homograft rib cartilage in saddle nose deformity. Arch Iran Med 15:235–238

    Google Scholar 

  57. Reinisch J, Tahiri Y (2018) Polyethylene ear reconstruction: a state-of-the-art surgical journey. Plast Reconstr Surg 141:461–470

    Article  CAS  Google Scholar 

  58. Reinisch JF, Lewin S (2009) Ear reconstruction using a porous polyethylene framework and temporoparietal fascia flap. Facial Plast Surg 25:181–189

    Article  CAS  Google Scholar 

  59. Rettinger G (1997) Reconstruction of the pronounced saddle nose. Laryngorhinootologie 76:672–675

    Article  CAS  Google Scholar 

  60. Riechelmann H, Rettinger G (2004) Three-step reconstruction of complex saddle nose deformities. Arch Otolaryngol Head Neck Surg 130:334–338

    Article  Google Scholar 

  61. Rodrigues Dias D, Santos M, Sousa ECS et al (2022) The spare roof technique as a new approach to the crooked nose. Facial Plast Surg Aesthet Med 24(3):178–184. https://doi.org/10.1089/fpsam.2021.0368

    Article  Google Scholar 

  62. Romo T 3rd, Sclafani AP, Sabini P (1998) Reconstruction of the major saddle nose deformity using composite allo-implants. Facial Plast Surg 14:151–157

    Article  Google Scholar 

  63. Roxbury C, Ishii M, Godoy A et al (2012) Impact of crooked nose rhinoplasty on observer perceptions of attractiveness. Laryngoscope 122:773–778

    Article  Google Scholar 

  64. Seifert LB, Mainka T, Herrera-Vizcaino C et al (2022) Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions. Eur J Trauma Emerg Surg 48:1427–1436

    Article  Google Scholar 

  65. Shipchandler TZ, Chung BJ, Alam DS (2008) Saddle nose deformity reconstruction with a split calvarial bone L‑shaped strut. Arch Facial Plast Surg 10:305–311

    Article  Google Scholar 

  66. Siegert R, Magritz R (2007) Reconstruction of the external ear. Laryngorhinootologie 86(1):S121–140

    Article  Google Scholar 

  67. Sivam A, Enninghorst N (2022) The dilemma of reconstructive material choice for orbital floor fracture: a narrative review. Medicines (Basel) 9(1):6. https://doi.org/10.3390/medicines9010006

    Article  CAS  Google Scholar 

  68. Steffen A, Katzbach R, Klaiber S (2006) A comparison of ear reattachment methods: a review of 25 years since Pennington. Plast Reconstr Surg 118:1358–1364

    Article  CAS  Google Scholar 

  69. Suh MK (2020) Correction of the deviated tip and columella in crooked nose. Arch Plast Surg 47:495–504

    Article  Google Scholar 

  70. Takahashi Y, Sabundayo MS, Miyazaki H et al (2017) Incarceration of the inferior oblique muscle branch of the oculomotor nerve in patients with orbital floor trapdoor fracture. Graefes Arch Clin Exp Ophthalmol 255:2059–2065

    Article  Google Scholar 

  71. Takaishi S, Iimura J, Otori N (2020) Endoscopic endonasal approach for repairing an outwardly herniated blow-out fracture lateral to the infraorbital nerve. Eur Arch Otorhinolaryngol 277:3227–3230

    Article  Google Scholar 

  72. Talbi M, Stussi JD, Meley M (2001) Microsurgical replantation of a totally amputated ear without venous repair. J Reconstr Microsurg 17:417–420

    Article  CAS  Google Scholar 

  73. Tanzer RC (1959) Total reconstruction of the external ear. Plast Reconstr Surg Transplant Bull 23:1–15

    Article  CAS  Google Scholar 

  74. Templer J, Renner GJ (1990) Injuries of the external ear. Otolaryngol Clin North Am 23:1003–1018

    Article  CAS  Google Scholar 

  75. Thomassin JM, Paris J, Richard-Vitton T (2001) Management and aesthetic results of support grafts in saddle nose surgery. Aesthetic Plast Surg 25:332–337

    Article  CAS  Google Scholar 

  76. Trufant JW, Marzolf S, Leach BC et al (2016) The utility of full-thickness skin grafts (FTSGs) for auricular reconstruction. J Am Acad Dermatol 75:169–176

    Article  Google Scholar 

  77. Turegun M, Sengezer M, Guler M (1998) Reconstruction of saddle nose deformities using porous polyethylene implant. Aesthetic Plast Surg 22:38–41

    Article  CAS  Google Scholar 

  78. Valdes Reyes JM, Zapata Ocampo S (2021) Functional classification of isolated zygomatic arch fracture: new proposal. J Craniofac Surg 32:757–758

    Article  Google Scholar 

  79. Walter C (1969) Problems of reconstruction of the ear auricle. HNO 17:301–305

    CAS  Google Scholar 

  80. Weerda H (1996) Acute trauma to the external ear. Treatment of chemical burns, freezing, burns and acute avulsions of the external ear. HNO 44:701–709

    Article  CAS  Google Scholar 

  81. Weerda H (2004) Chirurgie der Ohrmuschel: Verletzungen, Defekte und Anomalien. Thieme, Stuttgart

    Book  Google Scholar 

  82. Winters R, Chastant R, Graham HD 3rd (2014) When is immediate surgical intervention required for isolated orbital blowout fractures? Laryngoscope 124:585–586

    Article  Google Scholar 

  83. Yagmur C, Evin N, Kelahmetoglu O et al (2020) Counter autografting of dorsal septum in crooked nose. Aesthetic Plast Surg 44:1707–1715

    Article  Google Scholar 

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  1. Klinik für Hals-Nasen-Ohrenheilkunde, Universität Tübingen, Tübingen, Deutschland

    T. Albrecht

  2. Universitäts-HNO-Klinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    F. Wallner

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T. Albrecht und F. Wallner geben an, dass kein Interessenkonflikt besteht. Kein Ethikkommissionsvotum erforderlich, da Review.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Albrecht, T., Wallner, F. Rekonstruktionsmöglichkeiten nach Verletzungen der Kopf-Hals-Region. HNO 71, 57–62 (2023). https://doi.org/10.1007/s00106-022-01230-5

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