Agrillo Alessandro, Sassano Pierpaolo, Mustazza Maria Cristina, Filiaci Fabio
Department of Maxillo-Facial Surgery, University of Rome La Sapienza, Rome, Italy.
J Craniofac Surg. 2006 May;17(3):442-6. doi: 10.1097/00001665-200605000-00010.
Craniofacial traumas are one of the most common clinical events of the 21st century. The possibility of associated injuries of the head and neck may also determine functional and cosmetic problems in these patients. The most frequent pathologic conditions observed are contusions, lacerations, abrasions, avulsions, and the inclusion of foreign bodies. In particular, penetrating injuries represent a rare but complex variety of craniofacial trauma. Generally, the penetrating material is stiff enough to cross through different anatomic structures during a particularly violent collision caused by a road or work accident or during an attack. The therapeutic strategy adopted for this type of patient depends mainly on diagnostic procedures such as skull radiograms in different projections, computerized tomography, magnetic resonance imaging, and, occasionally, echotomography. However, on arrival at the emergency department, the clinical conditions of the patient will determine the type of investigation to be carried out. Last, to prevent any postoperative infections, wide spectrum antibiotic therapy is advisable. Ideally, imaging should be repeated postoperatively to confirm resolution of the initial clinical condition. In this article, the authors describe three unusual clinical cases of patients with penetrating injuries of the head and face together with the protocol adopted for treatment of such complex craniofacial injuries. The three cases described demonstrate that, despite the initial appearance of penetrating wounds, a correct diagnostic assessment followed by a suitable therapeutic protocol can reduce cosmetic and functional defects to a minimum.
颅面创伤是21世纪最常见的临床事件之一。头颈部合并损伤的可能性也可能决定这些患者的功能和美容问题。观察到的最常见病理状况为挫伤、撕裂伤、擦伤、撕脱伤以及异物嵌入。特别是，穿透性损伤是一种罕见但复杂的颅面创伤类型。一般来说，穿透物足够坚硬，在道路或工作事故引起的特别剧烈碰撞中或在袭击期间能够穿过不同的解剖结构。针对这类患者所采用的治疗策略主要取决于诊断程序，如不同投照角度的颅骨X线片、计算机断层扫描、磁共振成像，偶尔还包括超声断层扫描。然而，患者到达急诊科时的临床状况将决定要进行的检查类型。最后，为防止任何术后感染，建议采用广谱抗生素治疗。理想情况下，术后应重复进行影像学检查以确认初始临床状况已得到解决。在本文中，作者描述了三例头面部穿透性损伤患者的不寻常临床病例以及针对此类复杂颅面损伤所采用的治疗方案。所描述的这三例病例表明，尽管最初有穿透伤口的表现，但正确的诊断评估并随后采用合适的治疗方案可将美容和功能缺陷降至最低。
