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Vorgehen bei frontobasalen Frakturen

Diagnosis and Treatment in frontobasal fractures

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Zusammenfassung

Schädel-Hirn-Traumata können zu frontobasalen Frakturen (FBF) führen. Die Ziele der Therapie von FBF liegen in der Beseitigung einer primären Morbidität und/oder der Verhinderung einer sekundären Morbidität. Von besonderer Bedeutung ist hierbei die unmittelbare Nähe wichtiger Sinnesorgane für das Hören, Sehen, Riechen und Schmecken sowie deren versorgende nervale Strukturen. Anamnese, klinische Untersuchungsbefunde oder eine ggf. schon vorliegende Computertomographie (CT) sind hier wegweisend und sollten zu einer individuellen Bewertung führen. Je nach Ausprägung der Frakturen können folgende Fachdisziplinen an der Versorgung von FBF beteiligt sein: Neurochirurgie, plastische Chirurgie, Mund-Kiefer-Gesichts(MKG)-Chirurgie und/oder HNO-Heilkunde. Insbesondere ist die weniger invasive endoskopische endonasale Therapie bisher dem HNO-Chirurgen vorbehalten und hat sich in anderen Fachdisziplinen noch nicht umfassend etabliert. Die vorliegende Arbeit gibt einen Überblick über den aktuellen Stand zu folgenden Aspekten unter Berücksichtigung der aktuellen Literatur: Anatomische Grundlagen, Einteilung von Frakturen, Diagnostik (insbesondere klinische Untersuchung, Bildgebung, und laborchemische Tests), klinische Symptome sowie Therapie.

Abstract

Traumatic brain injury can result in frontobasal fractures (FBF). The goals of treatment for FBF are to eliminate primary morbidity and/or prevent secondary morbidity. Of particular importance in this regard is the proximity of important sensory organs for hearing, vision, smell, and taste, as well as their supplying nervous structures. Medical history, clinical findings, or CT scan are necessary and should lead to an individual evaluation. Depending on the severity of the fractures, the following disciplines may be involved in the treatment of FBF: neurosurgery, plastic surgery, oral and maxillofacial surgery, and/or otorhinolaryngology. Particularly less invasive endoscopic endonasal therapy is a specialty of otorhinolaryngologic surgeons and has not been widely established in other disciplines. The present work provides an overview of the current state of the art in terms of the following aspects, taking into account the current literature: anatomic principles, classification of fractures, diagnostics (in particular clinical examination, imaging, and laboratory chemistry tests), clinical symptoms, and treatment.

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Authors and Affiliations

  1. Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland

    F. Sommer, M. Brand, M. O. Scheithauer, T. K. Hoffmann & M.-N. Theodoraki

  2. Hals-Nasen-Ohrenklinik des Städtischen Klinikums Karlsruhe, Karlsruhe, Deutschland

    R. Weber

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  1. F. Sommer
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  5. M.-N. Theodoraki
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Correspondence to F. Sommer.

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F. Sommer, M. Brand, M. O. Scheithauer, T. K. Hoffmann, M.-N. Theodoraki und R. Weber geben an, dass kein Interessenkonflikt besteht.

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Die Autoren M.-N. Theodoraki und R. Weber haben zu gleichen Teilen zum Manuskript beigetragen.

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Sommer, F., Brand, M., Scheithauer, M.O. et al. Vorgehen bei frontobasalen Frakturen. HNO 71, 35–47 (2023). https://doi.org/10.1007/s00106-022-01256-9

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