Kühnel Thomas S, Reichert Torsten E
Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany.
Department of Maxillofacial Surgery, University of Regensburg, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015 Dec 22;14:Doc06. doi: 10.3205/cto000121. eCollection 2015.
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
面中部骨折因其复杂性、发生频率及其社会经济影响而构成严重的医学问题。不过，跨学科方法以及最新的诊断和外科技术在大多数情况下都能取得良好效果。交通事故是主要原因，30多岁的成年男性最常受到影响。鼻骨骨折、上颌骨和颧骨骨折的治疗方案已得到广泛认可，而额窦和眶尖损伤仍是当前的争论焦点。内镜手术的进展以及循证医学知识获取的局限性是相应章节关注的问题。至于额窦骨折，目前有一种明显的趋势是采用微创方法。额窦填塞术和颅骨化手术的数量似乎在减少。对于外伤性视神经损伤采用大剂量甲基强的松龙治疗，一些批评意见似乎是合理的。术中锥形束X线片和预成型钛网植入物用于眼眶重建是面中部创伤学中的新技术和重要方面。伴有脑脊液漏的前颅底骨折在内鼻内镜修复中显示出非常有前景的结果。
