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Management von stumpfen und scharfen Kehlkopfverletzungen

Management of blunt and penetrating laryngeal trauma

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Zusammenfassung

Patienten mit einem laryngotrachealen Trauma können sich in einer lebensbedrohlichen Situation befinden. Eine frühzeitige Erkennung der Verletzungsschwere und ggf. ein operativer Eingriff innerhalb der ersten 24–48 h erhöhen die Chance, ein gutes funktionelles Spätergebnis zu erzielen. Der Erhalt bzw. die Wiederherstellung der Stimme sowie der Schluckfunktion ist das langfristige Therapieziel. Eine genaue Einschätzung des Verletzungsausmaßes kann durch eine Kombination aus Computertomographie und flexibler Laryngotracheoskopie erfolgen. Die Symptome spiegeln oft nicht das Ausmaß der Verletzung wider, die von einer endolaryngealen Blutung bis zur vollständigen Laryngotrachealseparation reichen kann. Eine konservative Behandlung besteht aus Beobachtung mit symptomatischer Therapie. Dagegen kann die Operation eine endolaryngeale und/oder transzervikale Rekonstruktion beinhalten. Die Sicherung der Atemwege ist hierbei von größter Bedeutung.

Abstract

Patients presenting with laryngotracheal trauma can be in a life-threatening situation. Early recognition of the severity of the injury and, if necessary, surgical intervention within the first 24–48 h increases the chance of achieving a good functional late result. Preservation or restoration of voice and swallowing function is the long-term therapeutic goal. Precise assessment of the extent of the injury can be achieved using a combination of computed tomography and flexible laryngotracheoscopy. Symptoms often do not reflect the extent of the injury, which can vary from endolaryngeal hemorrhage to complete laryngotracheal separation. Conservative treatment consists of observation with symptomatic therapy. On the other hand, surgery may include endolaryngeal repair and/or transcervical reconstruction; securing the airways is of utmost importance.

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Authors and Affiliations

  1. Zentrum für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen, Klinikstraße 33, Ebene 1, 35392, Gießen, Deutschland

    Christoph Arens

  2. Klinik für HNO-Heilkunde/Plastische Operationen, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548, Gera, Deutschland

    Andreas H. Müller

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  1. Christoph Arens
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Correspondence to Christoph Arens or Andreas H. Müller.

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Interessenkonflikt

C. Arens und A.H. Müller geben an, dass kein Interessenkonflikt besteht.

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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Arens, C., Müller, A.H. Management von stumpfen und scharfen Kehlkopfverletzungen. HNO 71, 28–34 (2023). https://doi.org/10.1007/s00106-022-01238-x

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  • DOI: https://doi.org/10.1007/s00106-022-01238-x

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