Maier H, Tisch M, Lorenz K J, Danz B, Schramm A
Klinik und Poliklinik für HNO-Heilkunde/Kopf- und Halschirurgie, Kopfklinik am Bundeswehrkrankenhaus Ulm, Akademisches Krankenhaus der Universität Ulm, Oberer Eselsberg 40, 89081 Ulm, Deutschland.
HNO. 2011 Aug;59(8):765-82. doi: 10.1007/s00106-011-2349-1.
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.
穿透性头颈部损伤常伴有血管损伤和气道梗阻，可能危及生命。因此，在急诊治疗中，控制出血和稳定气道是首要任务。高速投射物、简易爆炸装置（IED）碎片和弹片可导致严重的组织损伤，这对头颈部外科医生来说是一项挑战。由于眼、中面部、咽、喉、气管、食管、神经、血管和脊柱等多个器官结构可能同时受伤，患者在急诊治疗后应被转诊至专业创伤中心进行多学科治疗。高速弹道伤曾一度局限于战场，自第二次世界大战以来在欧洲并不常见。因此，目前普通头颈外科医生的经验有限。随着恐怖主义事件的增加以及IED作为恐怖主义首选武器的使用，普通头颈外科医生了解弹道伤在大规模伤亡事件中的作用变得至关重要。本文讨论了穿透性头颈部损伤诊断和治疗的当前观点。
